@Article{info:doi/10.2196/11397,
author="DeJonckheere, Melissa
and Nichols, P. Lauren
and Vydiswaran, Vinod V. G.
and Zhao, Xinyan
and Collins-Thompson, Kevyn
and Resnicow, Kenneth
and Chang, Tammy",
title="Using Text Messaging, Social Media, and Interviews to Understand What Pregnant Youth Think About Weight Gain During Pregnancy",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="01",
volume="3",
number="2",
pages="e11397",
keywords="methods",
keywords="adolescents",
keywords="weight gain",
keywords="pregnancy",
keywords="text messaging",
keywords="social media",
keywords="natural language processing",
abstract="Background: The majority of pregnant youth gain more weight than recommended by the National Academy of Medicine guidelines. Excess weight gain during pregnancy increases the risk of dangerous complications during delivery, including operative delivery and stillbirth, and contributes to the risk of long-term obesity in both mother and child. Little is known regarding youth's perceptions of and knowledge about weight gain during pregnancy. Objective: The aim of this study was to describe the feasibility and acceptability of 3 novel data collection and analysis strategies for use with youth (social media posts, text message surveys, and semistructured interviews) to explore their experiences during pregnancy. The mixed-methods analysis included natural language processing and thematic analysis. Methods: To demonstrate the feasibility and acceptability of this novel approach, we used descriptive statistics and thematic qualitative analysis to characterize participation and engagement in the study. Results: Recruitment of 54 pregnant women aged between 16 and 24 years occurred from April 2016 to September 2016. All participants completed at least 1 phase of the study. Semistructured interviews had the highest rate of completion, yet all 3 strategies were feasible and acceptable to pregnant youth. Conclusions: This study has described a novel youth-centered strategy of triangulating 3 sources of mixed-methods data to gain a deeper understanding of a health behavior phenomenon among an at-risk population of youth. ",
doi="10.2196/11397",
url="https://formative.jmir.org/2019/2/e11397/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30932869"
}


@Article{info:doi/10.2196/11342,
author="Concannon, David
and Herbst, Kobus
and Manley, Ed",
title="Developing a Data Dashboard Framework for Population Health Surveillance: Widening Access to Clinical Trial Findings",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="04",
volume="3",
number="2",
pages="e11342",
keywords="data visualization",
keywords="data dashboards",
keywords="health and demographic surveillance",
keywords="sub-Saharan Africa",
keywords="treatment as prevention",
keywords="clinical trials",
keywords="demographics",
keywords="real-time",
keywords="data literacy",
abstract="Background: Population surveillance sites generate many datasets relevant to disease surveillance. However, there is a risk that these data are underutilized because of the volumes of data gathered and the lack of means to quickly disseminate analysis. Data visualization offers a means to quickly disseminate, understand, and interpret datasets, facilitating evidence-driven decision making through increased access to information. Objectives: This paper describes the development and evaluation of a framework for data dashboard design, to visualize datasets produced at a demographic health surveillance site. The aim of this research was to produce a comprehensive, reusable, and scalable dashboard design framework to fit the unique requirements of the context. Methods: The framework was developed and implemented at a demographic surveillance platform at the Africa Health Research Institute, in KwaZulu-Natal, South Africa. This context represents an exemplar implementation for the use of data dashboards within a population health-monitoring setting. Before the full launch, an evaluation study was undertaken to assess the effectiveness of the dashboard framework as a data communication and decision-making tool. The evaluation included a quantitative task evaluation to assess usability and a qualitative questionnaire exploring the attitudes to the use of dashboards. Results: The evaluation participants were drawn from a diverse group of users working at the site (n=20), comprising of community members, nurses, scientific and operational staff. Evaluation demonstrated high usability for the dashboard across user groups, with scientific and operational staff having minimal issues in completing tasks. There were notable differences in the efficiency of task completion among user groups, indicating varying familiarity with data visualization. The majority of users felt that the dashboards provided a clear understanding of the datasets presented and had a positive attitude to their increased use. Conclusions: Overall, this exploratory study indicates the viability of the data dashboard framework in communicating data trends within population surveillance setting. The usability differences among the user groups discovered during the evaluation demonstrate the need for the user-led design of dashboards in this context, addressing heterogeneous computer and visualization literacy present among the diverse potential users present in such settings. The questionnaire highlighted the enthusiasm for increased access to datasets from all stakeholders highlighting the potential of dashboards in this context. ",
doi="10.2196/11342",
url="https://formative.jmir.org/2019/2/e11342/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30946016"
}


@Article{info:doi/10.2196/formative.9910,
author="Harrington, A. Richard
and Scarborough, Peter
and Hodgkins, Charo
and Raats, M. Monique
and Cowburn, Gill
and Dean, Moira
and Doherty, Aiden
and Foster, Charlie
and Juszczak, Edmund
and Ni Mhurchu, Cliona
and Winstone, Naomi
and Shepherd, Richard
and Timotijevic, Lada
and Rayner, Mike",
title="A Pilot Randomized Controlled Trial of a Digital Intervention Aimed at Improving Food Purchasing Behavior: The Front-of-Pack Food Labels Impact on Consumer Choice Study",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="08",
volume="3",
number="2",
pages="e9910",
keywords="diet",
keywords="randomized controlled trial",
abstract="Background: Most food in the United Kingdom is purchased in supermarkets, and many of these purchases are routinely tracked through supermarket loyalty card data. Using such data may be an effective way to develop remote public health interventions and to measure objectively their effectiveness at changing food purchasing behavior. Objective: The Front-of-pack food Labels: Impact on Consumer Choice (FLICC) study is a pilot randomized controlled trial of a digital behavior change intervention. This pilot trial aimed to collect data on recruitment and retention rates and to provide estimates of effect sizes for the primary outcome (healthiness of ready meals and pizzas purchased) to inform a larger trial. Methods: The intervention consisted of a website where participants could access tailored feedback on previous purchases of ready meals and pizzas, set goals for behavior change, and model and practice the recommended healthy shopping behavior using traffic light labels. The control consisted of Web-based information on traffic light labeling. Participants were recruited via email from a list of loyalty card holders held by the participating supermarket. All food and drink purchases for the participants for the 6 months before recruitment, during the 6-week intervention period, and during a 12-week washout period were transferred to the research team by the participating supermarket. Healthiness of ready meals and pizzas was measured using a predeveloped scale based solely on the traffic light colors on the foods. Questionnaires were completed at recruitment, end of the intervention, and end of washout to estimate the effect of the intervention on variables that mediate behavior change (eg, belief and intention formation). Results: We recruited 496 participants from an initial email to 50,000 people. Only 3 people withdrew from the study, and purchase data were received for all other participants. A total of 208 participants completed all 3 questionnaires. There was no difference in the healthiness of purchased ready meals and pizzas between the intervention and control arms either during the intervention period (P=.32) or at washout (P=.59). Conclusions: Although the FLICC study did not find evidence of an impact of the intervention on food purchasing behavior, the unique methods used in this pilot trial are informative for future studies that plan to use supermarket loyalty card data in collaboration with supermarket partners. The experience of the trial showcases the possibilities and challenges associated with the use of loyalty card data in public health research. Trial Registration: ISRCTN Registry ISRCTN19316955; http://www.isrctn.com/ISRCTN19316955 (Archived by WebCite at http://www.webcitation.org/76IVZ9WjK) International Registered Report Identifier (IRRID): RR2-10.1186/s40814-015-0015-1 ",
doi="10.2196/formative.9910",
url="http://formative.jmir.org/2019/2/e9910/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30958277"
}


@Article{info:doi/10.2196/10990,
author="Heynsbergh, Natalie
and Heckel, Leila
and Botti, Mari
and O, Chul Seung
and Livingston, M. Patricia",
title="Development of a Smartphone App for Informal Carers of People With Cancer: Processes and Learnings",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="11",
volume="3",
number="2",
pages="e10990",
keywords="cancer",
keywords="carer",
keywords="smartphone",
keywords="mobile applications",
keywords="technology",
abstract="Background: There are few support systems available to informal carers who provide care to cancer patients. Smartphone apps have the capacity to reach large audiences and can provide information and support at a time convenient to carers. Objective: The aim of this study was to design a smartphone app prototype for carers of adults with cancer. Methods: A multiple-method design was used to develop a smartphone app. Current and past carers of people with any type of cancer were recruited from a public hospital, a private hospital, and a carer organization, who participated in either a focus group or phone interview. Carers answered questions about items to include in an app to address supportive care needs identified. Using carers' feedback, a smartphone app was designed and tested. Beta testing was conducted using a convenience sample of participants who completed scenarios to inform the app's design, functionality, and usability. Scenarios were timed and marked as complete or incomplete. Participants completed a questionnaire about the usability of the app. Beta testing occurred in 2 stages---a paper-based version of the app and an app-based test using the participants' preferred device. Alpha testing was completed internally to ensure the functionality of the app. Data were collected between May 2016 and August 2017. Results: A total of 33 carers participated in phone interviews and 12 in focus groups; their average age was 55 (SD 14) years, and 60\% (27/45) were female. The majority of carers (76\%, 25/33) had a positive attitude toward using smartphone apps. Carers noted that smartphone technology might improve their ability to seek information and support in managing their own health as well as the care needs of the person with cancer. Carers requested a variety of information and resources to be included in the app. Paper-based testing included the following: participants (N=10) were aged above 30 years (30\%, 3/10), 30 to 49 years (30\%, 3/10), and 50 years or above (40\%, 4/10), and 60\% (6/10) were male. Participants found the app user-friendly and pleasing in appearance. App-based testing included the following: participants (N=10) were aged above 30 years (20\%, 2/10), 30 to 49 years (30\%, 3/10), and 50 years or above (50\%, 5/10), and 50\% (5/10) were male. Participants reported the app to be user-friendly and easy to navigate. The majority (60\%, 6/10) of participants were unable to create a shortcut icon to add the app to the home screen of their phone. Conclusions: Carers highlighted the needed information and support to assist them during the caring period; they also reported having a positive attitude toward smartphone apps. The Carer Guide App is currently undergoing a pilot study to further test usability among carers of people with 1 cancer type. ",
doi="10.2196/10990",
url="http://formative.jmir.org/2019/2/e10990/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30973346"
}


@Article{info:doi/10.2196/10880,
author="Rothrock, E. Nan
and Bass, Michael
and Blumenthal, Andrea
and Gershon, C. Richard
and Hanson, Beate
and Joeris, Alexander
and Kaat, Aaron
and Morrison, Suzanne
and O'Toole, V. Robert
and Patel, Shalini
and Stover, Michael
and Weaver, J. Michael
and White, Raymond
and Varela Diaz, Maria
and Vrahas, S. Mark",
title="AO Patient Outcomes Center: Design, Implementation, and Evaluation of a Software Application for the Collection of Patient-Reported Outcome Measures in Orthopedic Outpatient Clinics",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="12",
volume="3",
number="2",
pages="e10880",
keywords="orthopedics",
keywords="patient reported outcome measures",
keywords="tablet computers",
abstract="Background: Patient-reported outcomes are increasingly utilized in routine orthopedic clinical care. Computer adaptive tests (CATs) from the Patient-Reported Outcomes Measurement Information System (PROMIS) offer a brief and precise assessment that is well suited for collection within busy clinical environments. However, software apps that support the administration and scoring of CATs, provide immediate access to patient-reported outcome (PRO) scores, and minimize clinician burden are not widely available. Objective: Our objective was to design, implement, and test the feasibility and usability of a Web-based system for collecting CATs in orthopedic clinics. Methods: AO Patient Outcomes Center (AOPOC) was subjected to 2 rounds of testing. Alpha testing was conducted in 3 orthopedic clinics to evaluate ease of use and feasibility of integration in clinics. Patients completed an assessment of PROMIS CATs and a usability survey. Clinicians participated in a brief semistructured interview. Beta-phase testing evaluated system performance through load testing and usability of the updated version of AOPOC. In both rounds of testing, user satisfaction, bugs, change requests, and performance of PROMIS CATs were captured. Results: Patient feedback supported the ease of use in completing an assessment in AOPOC. Across both phases of testing, clinicians rated AOPOC as easy to use but noted difficulties in integrating a Web-based software application within their clinics. PROMIS CATs performed well; the default assessment of 2 CATs was completed quickly (mean 9.5 items) with a satisfactory range of measurement. Conclusion: AOPOC was demonstrated to be an easy-to-learn and easy-to-use software application for patients and clinicians that can be integrated into orthopedic clinical care. The workflow disruption in integrating any type of PRO collection must be addressed if patients' voices are to be better integrated in clinical care. ",
doi="10.2196/10880",
url="https://formative.jmir.org/2019/2/e10880/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30977735"
}


@Article{info:doi/10.2196/12028,
author="Birnie, A. Kathryn
and Campbell, Fiona
and Nguyen, Cynthia
and Lalloo, Chitra
and Tsimicalis, Argerie
and Matava, Clyde
and Cafazzo, Joseph
and Stinson, Jennifer",
title="iCanCope PostOp: User-Centered Design of a Smartphone-Based App for Self-Management of Postoperative Pain in Children and Adolescents",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="22",
volume="3",
number="2",
pages="e12028",
keywords="postoperative pain",
keywords="smartphone",
keywords="mobile applications",
keywords="mHealth",
keywords="pain management",
keywords="self-management",
keywords="adolescent",
abstract="Background: Moderate to severe postoperative pain in children is common. Increased pediatric day surgeries have shifted postoperative pain management predominantly to the home setting. Mobile health technology has the potential to overcome barriers to pain care by improving access to self-management resources. However, pain apps generally lack scientific evidence and are highly underutilized due to lack of involvement of end users in their development. Thus, an evidence-based pain self-management smartphone app that incorporates the needs and perspective of children and adolescents (end users) has potential to improve postoperative pain management. Objective: This paper aimed to describe how the principles of user-centered design were applied to the development of iCanCope PostOp, a smartphone-based pain self-management app for children and adolescents after surgery. Specifically, it presents 2 completed phases of the user-centered design process (concept generation and ideation) for the iCanCope PostOp app. Methods: Phase 1 was a multisite needs assessment from the perspective of 19 children and adolescents who had undergone various day surgeries, 19 parents, and 32 multidisciplinary health care providers. Children, adolescents, and parents completed individual semistructured interviews, and health care providers participated in focus groups. Data were summarized using qualitative content analysis. Phase 2 developed a pain care algorithm for the app using Delphi surveys and a 2-day in-person design workshop with 11 multidisciplinary pediatric postoperative pain experts and 2 people with lived experience with postoperative pain. Results: Phase 1 identified self-management challenges to postoperative pain management and recovery; limited available resources and reliance on medications as a predominant postoperative pain management strategy; and shared responsibility of postoperative pain care by children and adolescents, parents, and health care providers. Key app functions of tracking pain, pain self-management strategies, and goal setting were identified as priorities. Phase 2 led to the successful and efficient generation of a complete preliminary pain care algorithm for the iCanCope PostOp app, including clinically relevant inputs for feasible assessment and reassessment of pain and function (rest or sleep, movement or play, and mood or worry), as well as a catalog of pain management advice to be pushed to end users (psychological, physical, pharmacological, and education). Conclusions: The concept ideation and generation phases of the user-centered design approach were successfully completed for the iCanCope PostOp app. Next steps will include design finalization, app development (iOS or Android), evaluation through a randomized controlled trial, and subsequent implementation of the iCanCope PostOp app in clinical care. ",
doi="10.2196/12028",
url="http://formative.jmir.org/2019/2/e12028/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31008704"
}


@Article{info:doi/10.2196/11489,
author="Breteler, JM Martine
and Janssen, H. Joris
and Spiering, Wilko
and Kalkman, J. Cor
and van Solinge, W. Wouter
and Dohmen, AJ Daan",
title="Measuring Free-Living Physical Activity With Three Commercially Available Activity Monitors for Telemonitoring Purposes: Validation Study",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="24",
volume="3",
number="2",
pages="e11489",
keywords="activity trackers",
keywords="telemedicine",
keywords="exercise",
abstract="Background: Remote monitoring of physical activity in patients with chronic conditions could be useful to offer care professionals real-time assessment of their patient's daily activity pattern to adjust appropriate treatment. However, the validity of commercially available activity trackers that can be used for telemonitoring purposes is limited. Objective: The purpose of this study was to test usability and determine the validity of 3 consumer-level activity trackers as a measure of free-living activity. Methods: A usability evaluation (study 1) and validation study (study 2) were conducted. In study 1, 10 individuals wore one activity tracker for a period of 30 days and filled in a questionnaire on ease of use and wearability. In study 2, we validated three selected activity trackers (Apple Watch, Misfit Shine, and iHealth Edge) and a fourth pedometer (Yamax Digiwalker) against the reference standard (Actigraph GT3X) in 30 healthy participants for 72 hours. Outcome measures were 95\% limits of agreement (LoA) and bias (Bland-Altman analysis). Furthermore, median absolute differences (MAD) were calculated. Correction for bias was estimated and validated using leave-one-out cross validation. Results: Usability evaluation of study 1 showed that iHealth Edge and Apple Watch were more comfortable to wear as compared with the Misfit Flash. Therefore, the Misfit Flash was replaced by Misfit Shine in study 2. During study 2, the total number of steps of the reference standard was 21,527 (interquartile range, IQR 17,475-24,809). Bias and LoA for number of steps from the Apple Watch and iHealth Edge were 968 (IQR ?5478 to 7414) and 2021 (IQR ?4994 to 9036) steps. For Misfit Shine and Yamax Digiwalker, bias was ?1874 and 2004, both with wide LoA of (13,869 to 10,121) and (?10,932 to 14,940) steps, respectively. The Apple Watch noted the smallest MAD of 7.7\% with the Actigraph, whereas the Yamax Digiwalker noted the highest MAD (20.3\%). After leave-one-out cross validation, accuracy estimates of MAD of the iHealth Edge and Misfit Shine were within acceptable limits with 10.7\% and 11.3\%, respectively. Conclusions: Overall, the Apple Watch and iHealth Edge were positively evaluated after wearing. Validity varied widely between devices, with the Apple Watch being the most accurate and Yamax Digiwalker the least accurate for step count in free-living conditions. The iHealth Edge underestimates number of steps but can be considered reliable for activity monitoring after correction for bias. Misfit Shine overestimated number of steps and cannot be considered suitable for step count because of the low agreement. Future studies should focus on the added value of remotely monitoring activity patterns over time in chronic patients. ",
doi="10.2196/11489",
url="http://formative.jmir.org/2019/2/e11489/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31017587"
}


@Article{info:doi/10.2196/12982,
author="Setiawan, Agus I. Made
and Zhou, Leming
and Alfikri, Zakiy
and Saptono, Andi
and Fairman, D. Andrea
and Dicianno, Edward Brad
and Parmanto, Bambang",
title="An Adaptive Mobile Health System to Support Self-Management for Persons With Chronic Conditions and Disabilities: Usability and Feasibility Studies",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="25",
volume="3",
number="2",
pages="e12982",
keywords="mHealth",
keywords="adaptive mHealth",
keywords="mobile apps",
keywords="telemedicine",
keywords="personalized medicine",
keywords="self-management",
keywords="self-care",
keywords="caregivers",
keywords="chronic disease",
keywords="persons with disabilities",
abstract="Background: Persons with chronic conditions and disabilities (PwCCDs) are vulnerable to secondary complications. Many of these secondary complications are preventable with proactive self-management and proper support. To enhance PwCCDs' self-management skills and conveniently receive desired support, we have developed a mobile health (mHealth) system called iMHere. In 2 previous clinical trials, iMHere was successfully used to improve health outcomes of adult participants with spina bifida and spinal cord injury. To further expand use of iMHere among people with various types of disabilities and chronic diseases, the system needs to be more adaptive to address 3 unique challenges: 1) PwCCDs have very diverse needs with regards to self-management support, 2) PwCCDs' self-management needs may change over time, and 3) it is a challenge to keep PwCCDs engaged and interested in long-term self-management. Objective: The aim of this study was to develop an adaptive mHealth system capable of supporting long-term self-management and adapting to the various needs and conditions of PwCCDs. Methods: A scalable and adaptive architecture was designed and implemented for the new version, iMHere 2.0. In this scalable architecture, a set of mobile app modules was created to provide various types of self-management support to PwCCDs with the ability to add more as needed. The adaptive architecture empowers PwCCDs with personally relevant app modules and allows clinicians to adapt these modules in response to PwCCDs' evolving needs and conditions over time. Persuasive technologies, social support, and personalization features were integrated into iMHere 2.0 to engage and motivate PwCCDs and support long-term usage. Two initial studies were performed to evaluate the usability and feasibility of the iMHere 2.0 system. Results: The iMHere 2.0 system consists of cross-platform client and caregiver apps, a Web-based clinician portal, and a secure 2-way communication protocol for providing interactions among these 3 front-end components, all supported by a back-end server. The client and caregiver apps have 12 adaptive app modules to support various types of self-management tasks. The adaptive architecture makes it possible for PwCCDs to receive personalized app modules relevant to their conditions with or without support from various types of caregivers. The personalization and persuasive technologies in the architecture can be used to engage PwCCDs for long-term usage of the iMHere 2.0 system. Participants of the usability study were satisfied with the iMHere 2.0 client app. The feasibility evaluation revealed several practical issues to consider when implementing the system on a large scale. Conclusions: We developed an adaptive mHealth system as a novel method to support diverse needs in self-management for PwCCDs that can dynamically change over time. The usability of the client app is high, and it was feasible for PwCCDs to use in supporting personalized and evolving self-care needs. ",
doi="10.2196/12982",
url="http://formative.jmir.org/2019/2/e12982/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31021324"
}


@Article{info:doi/10.2196/12662,
author="Huberty, Jennifer
and Eckert, Ryan
and Larkey, Linda
and Kurka, Jonathan
and Rodr{\'i}guez De Jes{\'u}s, A. Sue
and Yoo, Wonsuk
and Mesa, Ruben",
title="Smartphone-Based Meditation for Myeloproliferative Neoplasm Patients: Feasibility Study to Inform Future Trials",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="29",
volume="3",
number="2",
pages="e12662",
keywords="mindfulness",
keywords="meditation",
keywords="smartphone",
keywords="mHealth",
keywords="cancer",
keywords="quality of life",
abstract="Background: Myeloproliferative neoplasm (MPN) patients often report high symptom burden that persists despite the best available pharmacologic therapy. Meditation has gained popularity in recent decades as a way to manage cancer patient symptoms. Objective: The aim of this study was to examine the feasibility of 2 different consumer-based meditation smartphone apps in MPN patients and to examine the limited efficacy of smartphone-based meditation on symptoms compared with an educational control group. Methods: Patients (n=128) were recruited nationally through organizational partners and social media. Eligible and consented patients were enrolled into 1 of 4 groups, 2 of which received varying orders of 2 consumer-based apps (10\% Happier and Calm) and 2 that received one of the apps alone for the second 4 weeks of the 8-week intervention after an educational control condition. Participants were asked to perform 10 min of meditation per day irrespective of the app and the order in which they received the apps. Feasibility outcomes were measured at weeks 5 and 9 with a Web-based survey. Feasibility outcomes were acceptability, demand, and limited efficacy for depression, anxiety, pain intensity, sleep disturbance, sexual function, quality of life, global health, and total symptom burden. Results: A total of 128 patients were enrolled across all 4 groups, with 73.4\% (94/128) patients completing the intervention. Of the participants who completed the 10\% Happier app, 61\% (46/76) enjoyed it, 66\% (50/76) were satisfied with the content, and 77\% (59/76) would recommend to others. Of those who completed the Calm app, 83\% (56/68) enjoyed it, 84\% (57/68) were satisfied with the content, and 97\% (66/68) would recommend to others. Of those who completed the educational control, 91\% (56/61) read it, 87\% (53/61) enjoyed it, and 71\% (43/61) learned something. Participants who completed the 10\% Happier app averaged 31 (SD 33) min/week; patients completing the Calm app averaged 71 (SD 74) min/week. 10\% Happier app participants saw small effects on anxiety (P<.001 d=?0.43), depression (P=.02; d=?0.38), sleep disturbance (P=.01; d=?0.40), total symptom burden (P=.13; d=?0.27), and fatigue (P=.06; d=?0.30), and moderate effects on physical health (P<.001; d=0.52). Calm app participants saw small effects on anxiety (P=.29; d=?0.22), depression (P=.09; d=?0.29), sleep disturbance (P=.002; d=?0.47), physical health (P=.005; d=0.44), total symptom burden (P=.13; d=?0.27), and fatigue (P=.13; d=?0.27). Educational control participants (n=61) did not have effects on any patient-reported outcome except for a moderate effect on physical health (P<.001; d=0.77). Conclusions: Delivering meditation via the Calm app is feasible and scored higher in terms of feasibility when compared with the 10\% Happier app. The Calm app will be used to implement a randomized controlled trial, testing the effects of meditation on symptom burden in MPNs. Trial Registration: ClinicalTrials.gov NCT03726944; https://clinicaltrials.gov/ct2/show/NCT03726944 (Archived by WebCite at http://www.webcitation.org/77MVdFJwM) ",
doi="10.2196/12662",
url="http://formative.jmir.org/2019/2/e12662/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31033443"
}


@Article{info:doi/10.2196/11586,
author="van Beurden, B. Samantha
and Smith, R. Jane
and Lawrence, S. Natalia
and Abraham, Charles
and Greaves, J. Colin",
title="Feasibility Randomized Controlled Trial of ImpulsePal: Smartphone App--Based Weight Management Intervention to Reduce Impulsive Eating in Overweight Adults",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="30",
volume="3",
number="2",
pages="e11586",
keywords="weight loss",
keywords="mHealth",
keywords="digital behavior change",
keywords="obesity",
keywords="dual-process",
abstract="Background: ImpulsePal is a theory-driven (dual-process), evidence-informed, and person-centered smartphone app intervention designed to help people manage impulsive processes that prompt unhealthy eating to facilitate dietary change and weight loss. Objective: The aims of this study were to (1) assess the feasibility of trial procedures for evaluation of the ImpulsePal intervention, (2) estimate standard deviations of outcomes, and (3) assess usability of, and satisfaction with, ImpulsePal. Methods: We conducted an individually randomized parallel two-arm nonblinded feasibility trial. The eligibility criteria included being aged ?16 years, having a body mass index of ?25?kg/m2, and having access to an Android-based device. Weight was measured (as the proposed primary outcome for a full-scale trial) at baseline, 1 month, and 3 months of follow-up. Participants were randomized in a 2:1 allocation ratio to the ImpulsePal intervention or a waiting list control group. A nested action-research study allowed for data-driven refinement of the intervention across 2 cycles of feedback. Results: We screened 179 participants for eligibility, and 58 were randomized to the intervention group and 30 to the control group. Data were available for 74 (84\%, 74/88) participants at 1 month and 67 (76\%, 67/88) participants at 3 months. The intervention group (n=43) lost 1.03 kg (95\% CI 0.33 to 1.74) more than controls (n=26) at 1 month and 1.01?kg (95\% CI ?0.45 to 2.47) more than controls (n=43 and n=24, respectively) at 3 months. Feedback suggested changes to intervention design were required to (1) improve receipt and understanding of instructions and (2) facilitate further engagement with the app and its strategies. Conclusions: The evaluation methods and delivery of the ImpulsePal app intervention are feasible, and the trial procedures, measures, and intervention are acceptable and satisfactory to the participants. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 14886370; http://www.isrctn.com/ISRCTN14886370 (Archived by WebCite at http://www.webcitation.org/76WcEpZ51) ",
doi="10.2196/11586",
url="https://formative.jmir.org/2019/2/e11586/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31038464"
}


@Article{info:doi/10.2196/11242,
author="Newby, Katie
and Crutzen, Rik
and Brown, Katherine
and Bailey, Julia
and Saunders, John
and Szczepura, Ala
and Hunt, Jonny
and Alston, Tim
and Sadiq, Tariq S.
and Das, Satyajit",
title="An Intervention to Increase Condom Use Among Users of Chlamydia Self-Sampling Websites (Wrapped): Intervention Mapping and Think-Aloud Study",
journal="JMIR Form Res",
year="2019",
month="May",
day="01",
volume="3",
number="2",
pages="e11242",
keywords="sexually transmitted infection",
keywords="condoms",
keywords="sexual behavior",
keywords="young adult",
keywords="intervention development",
keywords="internet",
keywords="eHealth",
keywords="co-design",
abstract="Background: Young people aged 16-24 years are disproportionately affected by sexually transmitted infections (STIs). STIs can have serious health consequences for affected individuals and the estimated annual cost of treatment to the National Health Service is {\textsterling}620 million. Accordingly, the UK government has made reducing the rates of STIs among this group a priority. A missed opportunity to intervene to increase condom use is when young people obtain self-sampling kits for STIs via the internet. Objective: Our aim was to develop a theory-based tailored intervention to increase condom use for 16-24-years-olds accessing chlamydia self-sampling websites. Methods: The intervention, Wrapped, was developed using Intervention Mapping and was co-designed with young people. The following steps were performed: (1) identification of important determinants of condom use and evidence of their changeability using computer and digital interventions; (2) setting the intervention goal, performance objectives, and change objectives; (3) identification of Behavior Change Principles (BCPs) and practical strategies to target these determinants; and (4) development of intervention materials able to deliver the BCPs and practical strategies. Results: Users of existing chlamydia self-sampling websites are signposted to Wrapped after placing an order for a sampling kit. Salient barriers to condom use are identified by each user and relevant intervention components are allocated to target these. The components include the following: (1) a sample box of condoms, (2) an online condom distribution service, (3) a product for carrying condoms, (4) a condom demonstration video, (5) a series of videos on communication about condom use, and (6) erotic films of real couples discussing and demonstrating condom use. Conclusions: This intervention will be directed at young people who may be particularly receptive to messages and support for behavior change due to their testing status. ",
doi="10.2196/11242",
url="http://formative.jmir.org/2019/2/e11242/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31042156"
}


@Article{info:doi/10.2196/11958,
author="Edridge, Chloe
and Deighton, Jessica
and Wolpert, Miranda
and Edbrooke-Childs, Julian",
title="The Implementation of an mHealth Intervention (ReZone) for the Self-Management of Overwhelming Feelings Among Young People",
journal="JMIR Form Res",
year="2019",
month="May",
day="02",
volume="3",
number="2",
pages="e11958",
keywords="cluster trial",
keywords="behavioural difficulties",
keywords="schools",
keywords="mHealth, digital",
keywords="mental health",
keywords="mobile phone",
abstract="Background: The association between mental health difficulties and academic attainment is well established. There is increasing research on mobile health (mHealth) interventions to provide support for the mental health and education of young people. However, nonadoption and inadequate implementation of mHealth interventions are prevalent barriers to such trials. Objective: The aim of this study was to bridge this gap and examine the implementation of an mHealth intervention, ReZone, for young people in schools. Methods: Preliminary data for 79 students collected as part of a larger trial were analyzed. We additionally conducted postimplementation consultations with teachers. Results: ReZone was used 1043 times by 36 students in the intervention arm during the study period. Postimplementation teacher consultations provided data on implementation strategies, barriers, and facilitators. Conclusions: Implementation strategies, barriers, and facilitators for digital interventions need to be considered to limit nonadoption and inadequate implementation in larger trials. Important considerations involve tailoring the characteristics of the intervention to the requirements of the intended user group, the technology itself, and the organization in which it is implemented. Trial Registration: International Standard Randomised Controlled Trial Number: 13425994; http://www.isrctn.com/ISRCTN13425994 ",
doi="10.2196/11958",
url="http://formative.jmir.org/2019/2/e11958/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31045499"
}


@Article{info:doi/10.2196/12406,
author="Theis, P. Ryan
and Malik, M. Ali
and Thompson, A. Lindsay
and Shenkman, A. Elizabeth
and Pbert, Lori
and Salloum, G. Ramzi",
title="Considerations of Privacy and Confidentiality in Developing a Clinical Support Tool for Adolescent Tobacco Prevention: Qualitative Study",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="28",
volume="3",
number="2",
pages="e12406",
keywords="clinical decision support",
keywords="adolescent",
keywords="primary care",
keywords="tobacco use",
keywords="confidentiality",
keywords="implementation science",
keywords="qualitative research",
abstract="Background: Electronic clinical support tools show promise for facilitating tobacco screening and counseling in adolescent well-care. However, the application of support tools in pediatric settings has not been thoroughly studied. Successfully implementing support tools in local settings requires an understanding of barriers and facilitators from the perspective of both patients and providers. Objective: This paper aimed to present the findings of a qualitative study conducted to inform the development and implementation of a support tool for adolescent tobacco screening and counseling in 3 pediatric clinics in North Florida. The primary objective of the study was to test and collect information needed to refine a tablet-based support tool with input from patients and providers in the study clinics. Methods: A tablet prototype was designed to collect information from adolescents on tobacco susceptibility and use before their well-care visit and to present tobacco prevention videos based on their responses. Information collected from adolescents by the support tool would be available to providers during the visit to facilitate and streamline tobacco use assessment and counseling components of well-care. Focus groups with providers and staff from 3 pediatric clinics (n=24) identified barriers and facilitators to implementation of the support tool. In-depth interviews with racially and ethnically diverse adolescent patients who screened as susceptible to tobacco use (n=16) focused on acceptability and usability of the tool. All focus groups and interviews were audio-recorded and transcribed for team-based coding using thematic analysis. Results: Privacy and confidentiality of information was a salient theme. Both groups expressed concerns that the tool's audio and visual components would impede privacy and that parents may read their child's responses or exert control over the process. Nearly all adolescents stated they would be comfortable with the option to complete the tool at home via a Web portal. Most adolescents stated they would feel comfortable discussing tobacco with their doctor. Adolescent interviews elicited 3 emergent themes that added context to perspectives on confidentiality and had practical implications for implementation: (1) purity: an expressed lack of concern for confidentiality among adolescents with no reported history of tobacco use; (2) steadfast honesty: a commitment to being honest with parents and providers about tobacco use, regardless of the situation; and (3) indifference: a perceived lack of relevance of confidentiality, based on the premise that others will ``find out anyway'' if adolescents are using tobacco. Conclusions: This study informed several modifications to the intervention to address confidentiality and introduce efficiency to well-care visits. The support tool was integrated into the electronic health record system used by the study clinics and modified to offer videos to all adolescents regardless of their tobacco use or susceptibility. Future studies will further test the acceptability of the intervention in practice. ",
doi="10.2196/12406",
url="http://formative.jmir.org/2019/2/e12406/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31066687"
}


@Article{info:doi/10.2196/12679,
author="Lunde, Pernille
and Nilsson, Blakstad Birgitta
and Bergland, Astrid
and Bye, Asta",
title="Feasibility of a Mobile Phone App to Promote Adherence to a Heart-Healthy Lifestyle: Single-Arm Study",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="19",
volume="3",
number="2",
pages="e12679",
keywords="mHealth",
keywords="eHealth",
keywords="mobile phone app",
keywords="cardiac rehabilitation",
abstract="Background: Long-term maintenance of preventive activities is fundamental for achieving improved outcomes in cardiac rehabilitation (CR). Despite this, it has been shown to be a major challenge for many patients to follow recommendations and thereby adhere to a heart-healthy lifestyle. Mobile phone apps have been emphasized as potential tools to promote preventive activities after attendance in a CR program. Before commencing a trial to assess the potential effect of using an app to promote long-term adherence to preventive activities after attendance in CR, a study to assess if it is feasible to use an app is warranted. Objective: The goal of the research is to assess if it is feasible to use a mobile phone app for promoting and monitoring patients' adherence to a heart-healthy lifestyle after CR. Methods: The study included an experimental, pre-post single-arm trial lasting for 12 weeks. All patients received access to an app aimed to guide individuals to change or maintain a heart-healthy lifestyle. During the study period, patients received weekly, individualized monitoring through the app, based on their own goals. Feasibility outcomes assessed were recruitment rate, adherence to the app, resource requirements, and efficacy regarding capability to detect a change in quality of life, health status, and perceived goal achievement as well as evaluating ceiling and floor effect in these outcomes. Criteria for success were preset to be able to evaluate whether the app was feasible to use in a potential future RCT. Results: In total, 71\% (17/24) of the patients who completed CR were eligible for a potential RCT as well as for this study. All 14 patients included in the study used the app to promote preventive activities throughout the study. Satisfaction with the technology was high, and the patients found the technology-based follow-up intervention both useful and motivational. Ceiling effect was present in more than 20\% of the patients in several domains of the questionnaires evaluating quality of life (36-Item Short Form Health Survey and COOP/WONCA functional health assessments) and health status (EQ-5D). Overall self-rated health status (EuroQol Visual Analog Scale) and perceived goal achievement were found to be outcomes able to detect a change. Conclusions: Individual follow-up through an app after attendance in CR is feasible. All patients used the app for preventive activities and found the app both useful and motivating. Several points of guidance from the patients in the study have been adopted and incorporated into the final design of the RCT now in the field. ",
doi="10.2196/12679",
url="http://formative.jmir.org/2019/2/e12679/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31066684"
}


@Article{info:doi/10.2196/11364,
author="Mowforth, Daniel Oliver
and Davies, Marshall Benjamin
and Kotter, Reinhard Mark",
title="The Use of Smart Technology in an Online Community of Patients With Degenerative Cervical Myelopathy",
journal="JMIR Form Res",
year="2019",
month="May",
day="09",
volume="3",
number="2",
pages="e11364",
keywords="spinal cord diseases",
keywords="cervical vertebrae",
keywords="spinal osteophytosis",
keywords="spondylosis",
keywords="biomedical technology",
keywords="chronic disease",
keywords="follow-up studies",
abstract="Background: Degenerative cervical myelopathy (DCM) is a prevalent and progressively disabling neurological condition. Treatment is currently limited to surgery, the timing of which is not without controversy. New international guidelines recommend that all patients should undergo lifelong surveillance and those with moderate-to-severe or progressive disease should be offered surgery. Long-term surveillance will place substantial burden on health services and short clinic assessments may risk misrepresenting disease severity. The use of smart technology to monitor disease progression could provide an invaluable opportunity to lessen this burden and improve patient care. However, given the older demographic of DCM, the feasibility of smart technology use is unclear. Objective: The aim of this study was to investigate current usage of smart technology in patients with self-reported DCM to inform design of smart technology apps targeted at monitoring DCM disease progression. Methods: Google Analytics from the patient section of Myelopathy.org, an international DCM charity with a large online patient community, was analyzed over a 1-year period. A total of 15,761 sessions were analyzed. Results: In total, 39.6\% (295/744) of visitors accessed the website using a desktop computer, 35.1\% (261/744) using mobile, and 25.3\% (188/744) using a tablet. Of the mobile and tablet visitors, 98.2\% (441/449) utilized a touchscreen device. A total of 51.3\% (141/275) of mobile and tablet visitors used iPhone Operating System (iOS) and 45.8\% (126/275) used an Android operating system. Apple and Samsung were the most popular smart devices, utilized by 53.6\% (241/449) and 25.8\% (116/449) of visitors, respectively. The overall visitor age was representative of DCM trials. Smart technology was widely used by older visitors: 58.8\% (113/192) of mobile visitors and 84.2\% (96/114) of tablet visitors were aged 45 years or older. Conclusions: Smart technology is commonly used by DCM patients. DCM apps need to be iOS and Android compatible to be accessible to all patients. ",
doi="10.2196/11364",
url="http://formative.jmir.org/2019/2/e11364/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31094330"
}


@Article{info:doi/10.2196/11890,
author="Paulsen, Mohn Mari
and Varsi, Cecilie
and Paur, Ingvild
and Tangvik, Julie Randi
and Andersen, Frost Lene",
title="Barriers and Facilitators for Implementing a Decision Support System to Prevent and Treat Disease-Related Malnutrition in a Hospital Setting: Qualitative Study",
journal="JMIR Form Res",
year="2019",
month="May",
day="09",
volume="3",
number="2",
pages="e11890",
keywords="malnutrition",
keywords="implementation science",
keywords="eHealth",
keywords="qualitative research",
keywords="decision support systems, clinical",
abstract="Background: Disease-related malnutrition is a challenge among hospitalized patients. Despite guidelines and recommendations for prevention and treatment, the condition continues to be prevalent. The MyFood system is a recently developed decision support system to prevent and treat disease-related malnutrition. Objective: To investigate the possible implementation of the MyFood system in clinical practice, the aims of the study were (1) to identify current practice, routines, barriers, and facilitators of nutritional care; (2) to identify potential barriers and facilitators for the use of MyFood; and (3) to identify the key aspects of an implementation plan. Methods: A qualitative study was performed among nurses, physicians, registered dietitians, and middle managers in 2 departments in a university hospital in Norway. Focus group discussions and semistructured interviews were used to collect data. The Consolidated Framework for Implementation Research (CFIR) was used to create the interview guide and analyze the results. The transcripts were analyzed using a thematic analysis. Results: A total of 27 health care professionals participated in the interviews and focus groups, including nurses (n=20), physicians (n=2), registered dietitians (n=2), and middle managers (n=3). The data were analyzed within 22 of the 39 CFIR constructs. Using the 5 CFIR domains as themes, we obtained the following results: (1) Intervention characteristics: MyFood was perceived to have a relative advantage of being more trustworthy, systematic, and motivational and providing increased awareness of nutritional treatment compared with the current practice. Its lack of communication with the existing digital systems was perceived as a potential barrier; (2) Outer settings: patients from different cultural backgrounds with language barriers and of older age were potential barriers for the use of the MyFood system; (3) Inner settings: no culture for specific routines or systems related to nutritional care existed in the departments. However, tension for change regarding screening for malnutrition risk, monitoring and nutritional treatment was highlighted in all categories of interviewees; (4) Characteristics of the individuals: positive attitudes toward MyFood were present among the majority of the interviewees, and they expressed self-efficacy toward the perceived use of MyFood; (5) Process: providing sufficient information to everyone in the department was highlighted as key to the success of the implementation. The involvement of opinion leaders, implementation leaders, and champions was also suggested for the implementation plan. Conclusions: This study identified several challenges in the nutritional care of hospitalized patients at risk of malnutrition and deviations from recommendations and guidelines. The MyFood system was perceived as being more precise, trustworthy, and motivational than the current practice. However, several potential barriers were identified. The assessment of the current situation and the identification of perceived barriers and facilitators will be used in planning an implementation and effect study, including the creation of an implementation plan. ",
doi="10.2196/11890",
url="http://formative.jmir.org/2019/2/e11890/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31094333"
}


@Article{info:doi/10.2196/12132,
author="Ray, E. Anne
and Greene, Kathryn
and Hecht, L. Michael
and Barriage, C. Sarah
and Miller-Day, Michelle
and Glenn, D. Shannon
and Banerjee, C. Smita",
title="An E-Learning Adaptation of an Evidence-Based Media Literacy Curriculum to Prevent Youth Substance Use in Community Groups: Development and Feasibility of REAL Media",
journal="JMIR Form Res",
year="2019",
month="May",
day="09",
volume="3",
number="2",
pages="e12132",
keywords="substance use",
keywords="prevention",
keywords="media literacy",
keywords="e-learning",
keywords="adaptation",
abstract="Background: There is a need for evidence-based substance use prevention efforts that target high school-aged youth that are easy to implement and suitable for dissemination in school and community groups. The Youth Message Development (YMD) program is a brief, four-lesson, in-person curriculum that aims to prevent youth substance use through the development of youth media literacy. Specifically, YMD aims to increase understanding of advertising reach and costs, along with the techniques used to sell products; develop counterarguing and critical thinking skills in response to advertisements; and facilitate application of these skills to the development of youth-generated antisubstance messages. Although YMD has demonstrated evidence of success, it is limited by its delivery method and focus on alcohol and smoking. Objective: Study objectives were two-fold: (1) to adapt the YMD curriculum to a self-paced, interactive, electronic-learning (e-learning) format and expand its content to cover alcohol, combustible cigarettes, e-cigarettes, smokeless tobacco, marijuana, and prescription drugs, and (2) to test the feasibility of the adapted curriculum in partnership with a national youth organization. Methods: An iterative process was employed in partnership with the 4-H youth development organization and a technology developer and consisted of six phases: (1) focus groups to guide adaptation, (2) adaptation to an e-learning format renamed REAL media, (3) pilot-testing of the REAL media prototype to determine feasibility and acceptability, (4) program revisions, (5) usability testing of the revised prototype, and (6) final revisions. Focus groups and pilot and usability testing were conducted with 4-H youth club members and adult club leaders. Results: Focus group feedback guided the build of an e-learning prototype of REAL media, which consisted of five online levels and interactive content guided by a mix of narration and on-screen text. Results of a pilot test of the prototype were neutral to positive, and the program was refined based on end-user feedback. An independent usability test indicated that youth 4-H members felt favorably about navigating REAL media, and they reported high self-efficacy in applying skills learned in the program. Additional refinements to the program were made based on their feedback. Conclusions: The iterative build process involving the end user from the outset yielded an overall successful technology-driven adaptation of an evidence-based curriculum. This should increase the likelihood of effectively impacting behavioral outcomes as well as uptake within community organizations. ",
doi="10.2196/12132",
url="http://formative.jmir.org/2019/2/e12132/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31094328"
}


@Article{info:doi/10.2196/13324,
author="Nour, Monica
and Chen, Juliana
and Allman-Farinelli, Margaret",
title="Young Adults' Engagement With a Self-Monitoring App for Vegetable Intake and the Impact of Social Media and Gamification: Feasibility Study",
journal="JMIR Form Res",
year="2019",
month="May",
day="10",
volume="3",
number="2",
pages="e13324",
keywords="vegetables",
keywords="young adults",
keywords="mHealth",
keywords="social media",
keywords="experimental game",
abstract="Background: Social media and gamification have been used in digital interventions for improving nutrition behaviors of young adults, but few studies measure engagement. Objective: This feasibility study aimed to explore user engagement with a 4-week smartphone program for improving vegetable intake. Methods: A goal setting and self-monitoring app was developed for feasibility testing. We assessed if additional components of gaming and/or social media support increased engagement. A 2 {\texttimes} 2 factorial study design was used with participants randomly allocated to each group. Engagement with the app (usage) was captured via inbuilt software, which recorded total days of app usage (duration) and the frequency of logging vegetable intake. Uptake of the social media (Facebook) content was measured by tracking views, likes, and comments on posts. Results:  Out of the 110 potential participants who completed the prescreening questionnaire online, 97 were eligible (mean age 24.8 [SD 3.4]). In total, 49\% (47/97) of participants were retained at 4 weeks. Attrition within the first week was the highest among users of the gamified app without social support (Facebook; P<.001). Over the intervention period, 64\% (62/97) of participants logged into their app, with vegetable intake recorded on average for 11 out of 28 days. The frequency of recording decreased each week (mean 4 [SD 2] days in week 1 versus mean 2 [SD 2] days in week 4). No effects of gaming or social support on the frequency of recording vegetables or the duration of app engagement were found. However, regardless of the app type, the duration of app engagement was significantly associated with vegetable intake post intervention (P<.001). In total, 60\% of Facebook posts were viewed by participants but engagement was limited to likes, with no comments or peer-to-peer interaction observed. Conclusions: As duration of usage was associated with vegetable intake, a deeper understanding of factors influencing engagement is needed. Dimensions such as personal attributes and the setting and context require further exploration in addition to content and delivery. ",
doi="10.2196/13324",
url="http://formative.jmir.org/2019/2/e13324/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31094322"
}


@Article{info:doi/10.2196/13882,
author="Smelror, Elle Runar
and Bless, Johann Josef
and Hugdahl, Kenneth
and Agartz, Ingrid",
title="Feasibility and Acceptability of Using a Mobile Phone App for Characterizing Auditory Verbal Hallucinations in Adolescents With Early-Onset Psychosis: Exploratory Study",
journal="JMIR Form Res",
year="2019",
month="May",
day="14",
volume="3",
number="2",
pages="e13882",
keywords="experience sampling method",
keywords="ecological momentary assessment",
keywords="schizophrenia",
keywords="mHealth",
keywords="health care technology",
abstract="Background: Auditory verbal hallucinations (AVH) are the most frequent symptom in early-onset psychosis (EOP) and a risk factor for increased suicide attempts in adolescents. Increased knowledge of AVH characteristics can lead to better prediction of risk and precision of diagnosis and help identify individuals with AVH who need care. As 98\% of Norwegian adolescents aged 12 to 16 years own a mobile phone, the use of mobile phone apps in symptom assessment and patient communication is a promising new tool. However, when introducing new technology to patients, their subjective experiences are crucial in identifying risks, further development, and potential integration into clinical care. Objective: The objective was to explore the feasibility and acceptability of a newly developed mobile phone app in adolescents with EOP by examining compliance with the app and user experiences. Indication of validity was explored by examining associations between AVH dimensions, which were correlated and analyzed. Methods: Three adolescents with EOP and active AVH were enrolled. Real-time AVH were logged on an iPod touch using the experience sampling method (ESM), for seven or more consecutive days. The app included five dimensions of AVH characteristics and was programmed with five daily notifications. Feasibility and acceptability were examined using the mean response rate of data sampling and by interviewing the participants. Validity was assessed by examining associations between the AVH dimensions using nonparametric correlation analysis and by visual inspection of temporal fluctuations of the AVH dimensions. Results: One participant was excluded from the statistical analyses but completed the interview and was included in the examination of acceptability. The sampling period of the two participants was mean 12 (SD 6) days with overall completed sampling rate of 74\% (SD 30\%), indicating adequate to high compliance with the procedure. The user experiences from the interviews clustered into four categories: (1) increased awareness, (2) personal privacy, (3) design and procedure, and (4) usefulness and clinical care. One participant experienced more commenting voices during the sampling period, and all three participants had concerns regarding personal privacy when using electronic devices in symptom assessment. The AVH dimensions of content, control, and influence showed moderate to strong significant correlations with all dimensions (P<.001). Days of data sampling showed weak to moderate correlations with localization (P<.001) and influence (P=.03). Visual inspection indicated that the app was able to capture fluctuations within and across days for all AVH dimensions. Conclusions: This study demonstrates the value of including patients' experiences in the development and pilot-testing of new technology. Based on the small sample size, the use of mobile phones with ESM seems feasible for patients with EOP, but the acceptability of using apps should be considered. Further investigation with larger samples is warranted before definitive conclusions are made. ",
doi="10.2196/13882",
url="http://formative.jmir.org/2019/2/e13882/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31094321"
}


@Article{info:doi/10.2196/13446,
author="Thew, R. Graham
and Powell, LYM Candice
and Kwok, PL Amy
and Lissillour Chan, H. Mandy
and Wild, Jennifer
and Warnock-Parkes, Emma
and Leung, WL Patrick
and Clark, M. David",
title="Internet-Based Cognitive Therapy for Social Anxiety Disorder in Hong Kong: Therapist Training and Dissemination Case Series",
journal="JMIR Form Res",
year="2019",
month="May",
day="15",
volume="3",
number="2",
pages="e13446",
keywords="anxiety",
keywords="social phobia",
keywords="internet",
keywords="cognitive therapy",
keywords="clinical competence",
keywords="cross-cultural comparison",
keywords="Hong Kong",
keywords="benchmarking",
keywords="psychology, clinical",
keywords="mental health",
abstract="Background: Guided internet-based psychological interventions show substantial promise for expanding access to evidence-based mental health care. However, this can only be achieved if results of tightly controlled studies from the treatment developers can also be achieved in other independent settings. This dissemination depends critically on developing efficient and effective ways to train professionals to deliver these interventions. Unfortunately, descriptions of therapist training and its evaluation are often limited or absent within dissemination studies. Objective: This study aimed to describe and evaluate a program of therapist training to deliver internet-based Cognitive Therapy for social anxiety disorder (iCT-SAD). As this treatment was developed in the United Kingdom and this study was conducted in Hong Kong with local therapists, an additional objective was to examine the feasibility, acceptability, and initial efficacy of iCT-SAD in this cultural context, based on data from a pilot case series. Methods: Training in iCT-SAD was provided to 3 therapists and included practice of the face-to-face format of therapy under clinical supervision, training workshops, and treating 6 patients with the iCT-SAD program. Training progress was evaluated using standardized and self-report measures and by reviewing patient outcomes. In addition, feedback from patients and therapists was sought regarding the feasibility and acceptability of the program. Results: The training program was effective at increasing therapists' iCT-SAD knowledge and skills, resulting in levels of competence expected of a specialist Cognitive Behavioral Therapy practitioner. The 6 patients treated by the trainees all completed their treatment and achieved a mean pre- to posttreatment change of 53.8 points (SD 39.5) on the primary patient outcome measure, the Liebowitz Social Anxiety Scale. The within-group effect size (Cohen d) was 2.06 (95\% CI 0.66-3.46). There was evidence to suggest that the patients' clinical outcomes were sustained at 3-month follow-up. These clinical results are comparable to those achieved by UK patients treated by the developers of the internet program. Patient and therapist feedback did not identify any major cultural barriers to implementing iCT-SAD in Hong Kong; some modest language suggestions were made to assist understanding. Conclusions: The therapist training implemented here facilitated the successful dissemination of an effective UK-developed internet intervention to Hong Kong. The treatment appeared feasible and acceptable in this setting and showed highly promising initial efficacy. A randomized controlled trial is now required to examine this more robustly. As therapist training is critical to the successful dissemination of internet interventions, further research to develop, describe, and evaluate therapist training procedures is recommended. ",
doi="10.2196/13446",
url="http://formative.jmir.org/2019/2/e13446/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31094320"
}


@Article{info:doi/10.2196/12635,
author="Sato, Daisuke
and Sutoh, Chihiro
and Seki, Yoichi
and Nagai, Eiichi
and Shimizu, Eiji",
title="Treatment Preferences for Internet-Based Cognitive Behavioral Therapy for Insomnia in Japan: Online Survey",
journal="JMIR Form Res",
year="2019",
month="May",
day="15",
volume="3",
number="2",
pages="e12635",
keywords="patient preference",
keywords="insomnia",
keywords="internet-based cognitive behavioral therapy",
abstract="Background: The internet has the potential to increase individuals' access to cognitive behavioral therapy (CBT) for insomnia at low cost. However, treatment preferences regarding internet-based computerized CBT for insomnia have not been fully examined. Objective: The aim was to conduct an anonymous online survey to evaluate treatment preferences for insomnia among patients with insomnia and individuals without insomnia. Methods: We developed an online survey to recruit a total of 600 participants living in the Kanto district in Japan. There were three subgroups: 200 medicated individuals with insomnia, 200 unmedicated individuals with insomnia, and 200 individuals without insomnia. The survey asked questions about the severity of the respondent's insomnia (using the Athens Insomnia Scale), the frequency of sleep medication use and the level of satisfaction with sleep medication use, the respondent's knowledge of CBT, his or her preference for CBT for insomnia before drug therapy, preference for CBT versus drug therapy, and preference for internet-based CBT versus face-to-face CBT. Results: Of the 600 respondents, 47.7\% (286/600) indicated that they received CBT before drug therapy, and 57.2\% (343/600) preferred CBT for insomnia to drug therapy. In addition, 47.0\% (282/600) preferred internet-based CBT for insomnia to face-to-face CBT. Although the respondents with insomnia who were taking an insomnia medication had a relatively lower preference for internet-based CBT (40.5\%, 81/200), the respondents with insomnia who were not taking an insomnia medication had a relatively higher preference for internet-based CBT (55.5\%, 111/200). Conclusions: The results of our online survey suggest that approximately half of the people queried preferred CBT for insomnia to drug therapy, and half of the respondents preferred internet-based CBT for insomnia to face-to-face CBT. ",
doi="10.2196/12635",
url="http://formative.jmir.org/2019/2/e12635/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31094319"
}


@Article{info:doi/10.2196/10951,
author="Thomas, Sarah
and Pulman, Andy
and Thomas, Peter
and Collard, Sarah
and Jiang, Nan
and Dogan, Huseyin
and Davies Smith, Angela
and Hourihan, Susan
and Roberts, Fiona
and Kersten, Paula
and Pretty, Keith
and Miller, K. Jessica
and Stanley, Kirsty
and Gay, Marie-Claire",
title="Digitizing a Face-to-Face Group Fatigue Management Program: Exploring the Views of People With Multiple Sclerosis and Health Care Professionals Via Consultation Groups and Interviews",
journal="JMIR Form Res",
year="2019",
month="May",
day="22",
volume="3",
number="2",
pages="e10951",
keywords="multiple sclerosis",
keywords="fatigue",
keywords="telemedicine",
keywords="mobile health",
keywords="FACETS",
keywords="fatigue management",
abstract="Background: Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS) and is the main reason why people with MS stop working early. The MS Society in the United Kingdom funded a randomized controlled trial of FACETS---a face-to-face group-based fatigue management program for people with multiple sclerosis (pwMS)---developed by members of the research team. Given the favorable trial results and to help with implementation, the MS Society supported the design and printing of the FACETS manual and materials and the national delivery of FACETS training courses (designed by the research team) for health care professionals (HCPs). By 2015 more than 1500 pwMS had received the FACETS program, but it is not available in all areas and a face-to-face format may not be suitable for, or appeal to, everyone. For these reasons, the MS Society funded a consultation to explore an alternative Web-based model of service delivery. Objective: The aim of this study was to gather views about a Web-based model of service delivery from HCPs who had delivered FACETS and from pwMS who had attended FACETS. Methods: Telephone consultations were undertaken with FACETS-trained HCPs who had experience of delivering FACETS (n=8). Three face-to-face consultation groups were held with pwMS who had attended the FACETS program: London (n=4), Liverpool (n=4), and Bristol (n=7). The interviews and consultation groups were digitally recorded and transcribed. A thematic analysis was undertaken to identify key themes. Toward the end of the study, a roundtable meeting was held to discuss outcomes from the consultation with representatives from the MS Society, HCPs, and pwMS. Results: Key challenges and opportunities of designing and delivering an integrated Web-based version of FACETS and maintaining user engagement were identified across 7 themes (delivery, online delivery, design, group, engagement, interactivity, and HCP relationships). Particularly of interest were themes related to replicating the group dynamics and the lack of high-quality solutions that would support the FACETS' weekly homework tasks and symptom monitoring and management. Conclusions: A minimum viable Web-based version of FACETS was suggested as the best starting point for a phased implementation, enabling a solution that could then be added to over time. It was also proposed that a separate study should look to create a free stand-alone digital toolkit focusing on the homework elements of FACETS. This study has commenced with a first version of the toolkit in development involving pwMS throughout the design and build stages to ensure a user-centered solution. ",
doi="10.2196/10951",
url="http://formative.jmir.org/2019/2/e10951/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31120021"
}


@Article{info:doi/10.2196/10388,
author="Rodriguez, Sarah
and Hwang, Kevin
and Wang, Jing",
title="Connecting Home-Based Self-Monitoring of Blood Pressure Data Into Electronic Health Records for Hypertension Care: A Qualitative Inquiry With Primary Care Providers",
journal="JMIR Form Res",
year="2019",
month="May",
day="23",
volume="3",
number="2",
pages="e10388",
keywords="patient-generated health data",
keywords="connected health",
keywords="remote monitoring",
keywords="electronic health record",
keywords="hypertension",
keywords="patient reported outcome",
keywords="self-measured blood pressure",
keywords="self-monitoring of blood pressure",
abstract="Background: There is a lack of research on how to best incorporate home-based self-measured blood pressure (SMBP) measurements, combined with other patient-generated health data (PGHD), into electronic health record (EHR) systems in a way that promotes primary care workflow without burdening the primary care team with irrelevant or superfluous data. Objective: The purpose of this study was to explore the perspectives of primary care providers in utilizing SMBP measurements and integrating SMBP data into the clinical workflow for the management of hypertension in the primary care setting. Methods: A total of 13 primary care physicians were interviewed in total; 5 in individual interviews and 8 in a focus group. The interview questions were centered on (1) the value of SMBP in hypertension care, (2) needs of viewing SMBP and desired visual display, (3) desired alert algorithm and critical values, (4) needs for other PGHD, and (5) workflow of primary care team in utilizing SMBP. The interviews were audiotaped and transcribed verbatim, and a thematic analysis was performed to extract overarching themes. Results: The primary care experience of the 13 providers ranged from 5 to 35 years. The following themes emerged from the individual and focus group interviews: (1) ways to utilize SMBP measurements in primary care, (2) preferred visual display of SMBP, (3) patient condition determines preferred scheduling of patient SMBP measurements and provider's preferred frequency of viewing SMBP data, (4) effect of patient condition on alert parameters, (5) location to receive critical value alerts, (6) primary recipient of critical value alerts, and (7) the need of additional PGHD (eg, emotional stressors, food diary, and medication adherence) to provide context of SMBP values. Conclusions: The perspectives of primary care providers need to be incorporated into the design of a built-in interface in the EHR to incorporate SMBP and other PGHD. Future usability evaluation should be conducted with mock-up interfaces to solicit opinions on the optimal alert frequency and mechanism to best fit the workflow in the primary care setting. Future studies should examine how the utilization of a built-in interface that fully integrates SMBP measurements and PGHD into EHR systems can support patient self-management and thus, improve patient outcomes. ",
doi="10.2196/10388",
url="http://formative.jmir.org/2019/2/e10388/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31124468"
}


@Article{info:doi/10.2196/formative.9995,
author="Bond, T. Keosha
and Ramos, Raquel S.",
title="Utilization of an Animated Electronic Health Video to Increase Knowledge of Post- and Pre-Exposure Prophylaxis for HIV Among African American Women: Nationwide Cross-Sectional Survey",
journal="JMIR Form Res",
year="2019",
month="May",
day="29",
volume="3",
number="2",
pages="e9995",
keywords="eHealth interventions",
keywords="heterosexual",
keywords="African American women",
keywords="HIV risk behaviors, HIV prevention",
keywords="entertainment-education",
keywords="postexposure prophylaxis",
keywords="pre-exposure prophylaxis",
keywords="internet",
keywords="videos",
abstract="Background: Despite renewed focus on biomedical prevention strategies since the publication of several clinical trials highlighting the efficacy of pre-exposure prophylaxis (PrEP), knowledge of postexposure prophylaxis (PEP) and PrEP continues to remain scarce among women, especially among African American women who are disproportionally affected by HIV. In an effort to address this barrier and encourage uptake of PEP and PrEP, an electronic health (eHealth) video was created using an entertainment-education format. Objective: The study aimed to explore the feasibility, acceptability, and preference of an avatar-led, eHealth video, PEP and PrEP for Women, to increase awareness and knowledge of PEP and PrEP for HIV in a sample of African American women. Methods: A cross-sectional, Web-based study was conducted with 116 African American women aged 18 to 61 years to measure participants' perceived acceptability of the video on a 5-point scale: poor, fair, good, very good, and excellent. Backward stepwise regression was used to the find the outcome variable of a higher rating of the PEP and PrEP for Women video. Thematic analysis was conducted to explore the reasons for recommending the video to others after watching the eHealth video. Results: Overall, 89\% of the participants rated the video as good or higher. A higher rating of the educational video was significantly predicted by: no current use of drugs/alcohol (beta=?.814; P=.004), not having unprotected sex in the last 3 months (beta=?.488; P=.03), higher income (beta=.149; P=.03), lower level of education (beta=?.267; P=.005), and lower exposure to sexual assault since the age of 18 years (beta=?.313; P=.004). After watching the eHealth video, reasons for recommending the video included the video being educational, entertaining, and suitable for women. Conclusions: Utilization of an avatar-led eHealth video fostered education about PEP and PrEP among African American women who have experienced insufficient outreach for biomedical HIV strategies. This approach can be leveraged to increase awareness and usage among African American women. ",
doi="10.2196/formative.9995",
url="http://formative.jmir.org/2019/2/e9995/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31144667"
}


@Article{info:doi/10.2196/12550,
author="Gulliver, Amelia
and Banfield, Michelle
and Morse, R. Alyssa
and Reynolds, Julia
and Miller, Sarah
and Galati, Connie",
title="A Peer-Led Electronic Mental Health Recovery App in a Community-Based Public Mental Health Service: Pilot Trial",
journal="JMIR Form Res",
year="2019",
month="Jun",
day="04",
volume="3",
number="2",
pages="e12550",
keywords="peer work",
keywords="computers, handheld",
keywords="pilot study",
keywords="mental health recovery",
keywords="mental health services, community",
keywords="mental disorders",
abstract="Background: There is an increasing need for peer workers (people with lived experience of mental health problems who support others) to work alongside consumers to improve recovery and outcomes. In addition, new forms of technology (tablet or mobile apps) can deliver services in an engaging and innovative way. However, there is a need to evaluate interventions in real-world settings. Objective: This exploratory proof-of-concept study aimed to determine if a peer worker--led electronic mental health (e-mental health) recovery program is a feasible, acceptable, and effective adjunct to usual care for people with moderate-to-severe mental illness. Methods: Overall, 6 consumers and 5 health service staff participated in the evaluation of a peer-led recovery app delivered at a community-based public mental health service. The peer worker and other health professional staff invited attendees at the drop-in medication clinics to participate in the trial during June to August 2017. Following the intervention period, participants were also invited by the peer worker to complete the evaluation in a separate room with the researcher. Consumers were explicitly informed that participation in the research evaluation was entirely voluntary. Consumer evaluation measures at postintervention included recovery and views on the acceptability of the program and its delivery. Interviews with staff focused on the acceptability and feasibility of the app itself and integrating a peer worker into the health care service. Results: Consumer recruitment in the research component of the study (n=6) fell substantially short of the target number of participants (n=30). However, from those who participated, both staff and consumers were highly satisfied with the peer worker and somewhat satisfied with the app. Health care staff overall believed that the addition of the peer worker was highly beneficial to both the consumers and staff. Conclusions: The preliminary findings from this proof-of-concept pilot study suggest that a peer-led program may be a feasible and acceptable method of working on recovery in this population. However, the e-mental health program did not appear feasible in this setting. In addition, recruitment was challenging in this particular group, and it is important to note that these study findings may not be generalizable. Despite this, ensuring familiarity of technology in the target population before implementing e-mental health interventions is likely to be of benefit. ",
doi="10.2196/12550",
url="http://formative.jmir.org/2019/2/e12550/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31165708"
}


@Article{info:doi/10.2196/13916,
author="Huppelschoten, Gerarda Aleida
and de Bruin, Peter Jan
and Kremer, AM Jan",
title="Independent and Web-Based Advice for Infertile Patients Using Fertility Consult: Pilot Study",
journal="JMIR Form Res",
year="2019",
month="Jun",
day="04",
volume="3",
number="2",
pages="e13916",
keywords="patient-centered care",
keywords="remote consultation",
keywords="decision making",
keywords="telemedicine",
abstract="Background: Patient-centered care---that is, care tailored to personal wishes and needs of patients---has become increasingly important. It is especially relevant in health care areas where patients suffer from a high burden of disease, such as fertility care. At present, both diagnosis and treatment for infertile couples is provided at a single hospital. As a consequence, patients are not likely to receive optimal, independent advice regarding their fertility problems. Internet-based, independent advice could be feasible for large groups of patients because it is not limited by travel distance and overhead costs. Objective: The aim of this study was to explore the experiences of both patients and professionals with an online platform using video consultations for patients with infertility seeking independent advice for their fertility problem. Methods: This pilot study evaluated an online platform, Fertility Consult, where patients with infertility can get independent advice by a gynecologist through a video consultation, thus eliminating the need of meeting the doctor physically. Semistructured interviews were performed with 2 gynecologists and the chairman of the Dutch patients association. This information was used for a patients' questionnaire about their first experiences with Fertility Consult, including questions about the level of patient-centeredness and shared decision making, using the Patient-Centered Questionnaire-Infertility (PCQ-Infertility) and the CollaboRATE questionnaire, respectively. Results: Of the first 27 patients enrolled at Fertility Consult, 22 responded (82\%). Most patients (82\%) visited Fertility Consult for a second opinion, seeking more personal attention and independent advice. The mean level of patient-centeredness on the PCQ-Infertility questionnaire was 2.78 (SD 0.58) on a scale of 0 to 3. For the CollaboRATE questionnaire (scale 0-9), patients provided a median score of 8.0 (range 7-9) on all 3 questions about shared decision making. Conclusions: Patients were satisfied with independent, well-prepared, Web-based advice; health care professionals felt they were able to provide patients with proper advice in a manner befitting patients' needs, without any loss of quality. Future studies should focus more on the separation of advice and treatment and on Web-based consultations compared with face-to-face consultations to ascertain the possibility of increased patient involvement in the process to improve the level of patient-centered care. ",
doi="10.2196/13916",
url="http://formative.jmir.org/2019/2/e13916/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31165714"
}


@Article{info:doi/10.2196/13633,
author="Ose, Osborg Solveig
and F{\ae}revik, Hilde
and Kaasb{\o}ll, Jannike
and Lindgren, Martin
and Thaulow, Kristin
and Antonsen, Stig
and Burkeland, Olav",
title="Exploring the Potential for Use of Virtual Reality Technology in the Treatment of Severe Mental Illness Among Adults in Mid-Norway: Collaborative Research Between Clinicians and Researchers",
journal="JMIR Form Res",
year="2019",
month="Jun",
day="10",
volume="3",
number="2",
pages="e13633",
keywords="virtual reality",
keywords="severe mental illness",
keywords="collaborative research",
keywords="technology",
keywords="social work",
abstract="Background: Virtual reality (VR) technology is not currently used in the treatment of severe mental health illness in Norway. Objective: We aimed to explore the potential of VR as a treatment for severe mental health illness in Norway, through collaborative research between clinicians and researchers. Methods: A collaborative research team was established, comprising researchers, the manager at a district psychiatric center, and the manager of the local municipal mental health service. An all-day workshop with eight clinicians---four from specialist mental health services and four from municipal mental health services---was conducted. The clinicians watched three different VR movies and after each one, they answered predefined questions designed to reflect their immediate thoughts about VR's potential use in clinical practice. At the end of the workshop, two focus group interviews, each with four clinicians from each service level, were conducted. Results: VR technology in specialist services might be a new tool for the treatment of severe mental health illness. In municipal mental health services, VR might particularly be useful in systematic social training that would otherwise take a very long time to complete. Conclusions: We found substantial potential for the use of VR in the treatment of severe mental health illness in specialist and municipal mental health services. One of the uses of VR technology with the greatest potential was helping individuals who had isolated themselves and needed training in social skills and everyday activity to enable them to have more active social lives. VR could also be used to simulate severe mental illness to provide a better understanding of how the person with severe mental illness experiences their situation. ",
doi="10.2196/13633",
url="http://formative.jmir.org/2019/2/e13633/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31199315"
}


@Article{info:doi/10.2196/13558,
author="Bartlett Ellis, J. Rebecca
and Hill, H. James
and Kerley, Denise K.
and Sinha, Arjun
and Ganci, Aaron
and Russell, L. Cynthia",
title="The Feasibility of a Using a Smart Button Mobile Health System to Self-Track Medication Adherence and Deliver Tailored Short Message Service Text Message Feedback",
journal="JMIR Form Res",
year="2019",
month="Jun",
day="25",
volume="3",
number="2",
pages="e13558",
keywords="medication adherence",
keywords="medication compliance",
keywords="behavior change",
abstract="Background: As many as 50\% of people experience medication nonadherence, yet studies for detecting nonadherence and delivering real-time interventions to improve adherence are lacking. Mobile health (mHealth) technologies show promise to track and support medication adherence. Objective: The study aimed to evaluate the feasibility and acceptability of using an mHealth system for medication adherence tracking and intervention delivery. The mHealth system comprises a smart button device to self-track medication taking, a companion smartphone app, a computer algorithm used to determine adherence and then deliver a standard or tailored SMS (short message service) text message on the basis of timing of medication taking. Standard SMS text messages indicated that the smartphone app registered the button press, whereas tailored SMS text messages encouraged habit formation and systems thinking on the basis of the timing the medications were taken. Methods: A convenience sample of 5 adults with chronic kidney disease (CKD), who were prescribed antihypertensive medication, participated in a 52-day longitudinal study. The study was conducted in 3 phases, with a standard SMS text message sent in phases 1 (study days 1-14) and 3 (study days 46-52) and tailored SMS text messages sent during phase 2 (study days 15-45) in response to participant medication self-tracking. Medication adherence was measured using: (1) the smart button and (2) electronic medication monitoring caps. Concordance between these 2 methods was evaluated using percentage of measurements made on the same day and occurring within {\textpm}5 min of one another. Acceptability was evaluated using qualitative feedback from participants. Results: A total of 5 patients with CKD, stages 1-4, were enrolled in the study, with the majority being men (60\%), white (80\%), and Hispanic/Latino (40\%) of middle age (52.6 years, SD 22.49; range 20-70). The mHealth system was successfully initiated in the clinic setting for all enrolled participants. Of the expected 260 data points, 36.5\% (n=95) were recorded with the smart button and 76.2\% (n=198) with electronic monitoring. Concordant events (n=94), in which events were recorded with both the smart button and electronic monitoring, occurred 47\% of the time and 58\% of these events occurred within {\textpm}5 min of one another. Participant comments suggested SMS text messages were encouraging. Conclusions: It was feasible to recruit participants in the clinic setting for an mHealth study, and our system was successfully initiated for all enrolled participants. The smart button is an innovative way to self-report adherence data, including date and timing of medication taking, which were not previously available from measures that rely on recall of adherence. Although the selected smart button had poor concordance with electronic monitoring caps, participants were willing to use it to self-track medication adherence, and they found the mHealth system acceptable to use in most cases. ",
doi="10.2196/13558",
url="http://formative.jmir.org/2019/2/e13558/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31237568"
}


@Article{info:doi/10.2196/12657,
author="Pima, Maganga Francis
and Oshosen, Martha
and Ngowi, Michael Kennedy
and Habte, Messele Bruck
and Maro, Eusebious
and Teffera, Eshete Belete
and Kisigo, Godfrey
and Swai, Ufoo Iraseni
and Msangi, Semvua Salim
and Ermias, Amha
and Mmbaga, T. Blandina
and Both, Rosalijn
and Sumari-de Boer, Marion",
title="Feasibility of Using Short Message Service and In-Depth Interviews to Collect Data on Contraceptive Use Among Young, Unmarried, Sexually Active Men in Moshi, Tanzania, and Addis Ababa, Ethiopia: Mixed Methods Study With a Longitudinal Follow-Up",
journal="JMIR Form Res",
year="2019",
month="Jun",
day="26",
volume="3",
number="2",
pages="e12657",
keywords="SMS",
keywords="contraceptives",
keywords="sexual behavior",
keywords="feasibility",
keywords="young unmarried men",
abstract="Background: Data on contraceptive needs and use among young unmarried men are limited. Conventional ways of data collection may lead to limited and unreliable information on contraceptive use due to sensitivity of the topic, as many young men feel ashamed to discuss their behavior of using contraceptives. As short message service (SMS) is anonymous and a commonly used means of communication, we believe that if deployed, it will create a promising user-friendly method of data collection. Objective: The objective was to investigate the feasibility of using SMS to collect data on sexually active, young, unmarried men's sexual behavior and contraceptive preferences, practices, and needs in Addis Ababa, Ethiopia, and Moshi, Tanzania. Methods: We enrolled men aged 18-30 years who were students (in Ethiopia and Tanzania), taxi or local bus drivers/assistants (Ethiopia and Tanzania), Kilimanjaro porters (Tanzania), or construction workers (Ethiopia). Young men were interviewed using a topic list on contraceptive use. They were followed up for 6 months by sending fortnightly SMS texts with questions about contraceptive use. If the young men indicated that they needed contraceptives during the reporting period or were not satisfied with the method they used, they were invited for a follow-up interview. At the end of the study, we conducted exit interviews telephonically using a semistructured questionnaire to explore the feasibility, acceptability, and accuracy of using SMS to validate the study findings in both countries. Results: We enrolled 71 young unmarried men---35 in Tanzania and 36 in Ethiopia. In Moshi, 1908 messages were delivered to participants and 1119 SMS responses were obtained. In Ethiopia, however, only 525 messages were sent to participants and 248 replies were received. The question on dating a girl in the past weeks was asked 438 times in Tanzania and received 252 (58\%) replies, of which 148 (59\%) were ``YES.'' In Ethiopia, this question was asked 314 times and received 64 (20\%) replies, of which 52 (81\%) were ``YES'' (P=.02 for difference in replies between Tanzania and Ethiopia). In Tanzania, the question on contraceptive use was sent successfully 112 times and received 108 (96\%) replies, of which 105 (94\%) were ``YES.'' In Ethiopia, the question on contraceptive use was asked 17 times and received only 2 (11\%) replies. Exit interviews in Tanzania showed that SMS was accepted as a means of data collection by 22 (88\%) of the 25 interviewed participants. Conclusions: Despite network and individual challenges, the SMS system was found to be feasible in Moshi, but not in Addis Ababa. We recommend more research to scale up the method in different groups and regions. ",
doi="10.2196/12657",
url="http://formative.jmir.org/2019/2/e12657/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31244476"
}


@Article{info:doi/10.2196/13870,
author="Vidal-Alaball, Josep
and Fernandez-Luque, Luis
and Marin-Gomez, X. Francesc
and Ahmed, Wasim",
title="A New Tool for Public Health Opinion to Give Insight Into Telemedicine: Twitter Poll Analysis",
journal="JMIR Form Res",
year="2019",
month="May",
day="28",
volume="3",
number="2",
pages="e13870",
keywords="telemedicine",
keywords="Twitter messaging",
keywords="health care surveys",
abstract="Background: Telemedicine draws on information technologies in order to enable the delivery of clinical health care from a distance. Twitter is a social networking platform that has 316 million monthly active users with 500 million tweets per day; its potential for real-time monitoring of public health has been well documented. There is a lack of empirical research that has critically examined the potential of Twitter polls for providing insight into public health. One of the benefits of utilizing Twitter polls is that it is possible to gain access to a large audience that can provide instant and real-time feedback. Moreover, Twitter polls are completely anonymized. Objective: The overall aim of this study was to develop and disseminate Twitter polls based on existing surveys to gain real-time feedback on public views and opinions toward telemedicine. Methods: Two Twitter polls were developed utilizing questions from previously used questionnaires to explore acceptance of telemedicine among Twitter users. The polls were placed on the Twitter timeline of one of the authors, which had more than 9300 followers, and the account followers were asked to answer the poll and retweet it to reach a larger audience. Results: In a population where telemedicine was expected to enjoy big support, a significant number of Twitter users responding to the poll felt that telemedicine was not as good as traditional care. Conclusions: Our results show the potential of Twitter polls for gaining insight into public health topics on a range of health issues not just limited to telemedicine. Our study also sheds light on how Twitter polls can be used to validate and test survey questions. ",
doi="10.2196/13870",
url="http://formative.jmir.org/2019/2/e13870/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31140442"
}


@Article{info:doi/10.2196/10688,
author="Harshbarger, Camilla
and Burrus, Olivia
and Zulkiewicz, A. Brittany
and Ortiz, M. Alexa
and Galindo, A. Carla
and Garner, R. Bryan
and Furberg, D. Robert
and Lewis, A. Megan",
title="Implementing Web-Based Interventions in HIV Primary Care Clinics: Pilot Implementation Evaluation of Positive Health Check",
journal="JMIR Form Res",
year="2019",
month="Apr",
day="18",
volume="3",
number="2",
pages="e10688",
keywords="internet",
keywords="patient care",
keywords="attitudes",
keywords="vulnerable populations",
keywords="public health practice",
abstract="Background: Web-based interventions can help people living with HIV achieve better clinical outcomes and behaviors, but integrating them into clinical practice remains challenging. There is a gap in understanding the feasibility of implementing these interventions in HIV clinic settings from the clinicians' perspective. Objective: The goal of the research was to determine whether Positive Health Check (PHC)---a Web-based, tailored video counseling tool focused on increasing patient adherence and retention in care and reducing HIV risk among HIV-positive patients---was acceptable, appropriate, and feasible for HIV primary care clinic staff to implement in clinic workflows. Methods: A multiple-case study design was used to evaluate the pilot implementation. Four primary care clinics located in the southeastern United States implemented PHC over a 1-month period. Nine clinic staff across the clinics participated in structured interviews before, during, and after the implementation. In total, 54 interviews were conducted. We used a framework analysis approach to code the data and identify themes related to implementation outcomes, including acceptability, appropriateness, and feasibility. We also analyzed patient intervention use metrics (n=104) to quantify patient intervention completion rates (n=68). Results: Overall, clinicians viewed PHC as acceptable and appropriate. Themes that emerged related to these implementation outcomes include the ability for PHC to increase provider-patient communication and its ability to engage patients due to the tailored and interactive design. While generally feasible to implement, challenges to the clinic workflow and physical environment were areas that clinics needed to manage to make PHC work in their clinics. Conclusions: Findings from this pilot implementation suggest that clinical staff viewed PHC as acceptable and appropriate, especially as more patients used the intervention over the pilot period. Feasibility of implementation was challenging in some cases, and lessons learned from this pilot implementation can provide information for larger scale tests of the intervention that include assessment of both implementation outcomes and clinical outcomes. ",
doi="10.2196/10688",
url="http://formative.jmir.org/2019/2/e10688/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30998219"
}


@Article{info:doi/10.2196/12248,
author="Mancinelli, Elisa
and Bassi, Giulia
and Salcuni, Silvia",
title="Predisposing and Motivational Factors Related to Social Network Sites Use: Systematic Review",
journal="JMIR Form Res",
year="2019",
month="Jun",
day="9",
volume="3",
number="2",
pages="e12248",
keywords="social networks",
keywords="individual differences",
keywords="motivation",
keywords="adolescents",
keywords="adults",
abstract="Background: Social network sites (SNSs) have been defined as Web services that involve creating a private or semiprivate profile. Through these services, adolescents and adults can maintain and create new relationships. Adolescents, in particular, can be considered the main users of these sites as they spend a lot of time on SNSs. In using SNSs, individuals can exert greater control over the conversation and on the information shared, which is associated with a desire for self-presentation. Moreover, the need for self-presentation is related to personality traits such as those of the Big Five, namely extraversion, neuroticism, openness to experience, agreeableness, and conscientiousness, as well as emotional stability, introversion, narcissism, and motivational aspects. The latter are usually linked to an underlying social purpose that might predispose an individual to using SNSs, with the intent of satisfying particular needs, such as belongingness and interpersonal competency. Objective: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, this study aimed to present a systematic review of the scientific literature regarding the predisposing factors related to the Big Five personality traits and motivational aspects associated with the use of SNSs, for both adolescents (12-19 years) and adults (>20 years). Methods: A search ranging from 2007 to 2017 was conducted through the academic database of Google Scholar and PsycINFO, in which the following terms and their derivatives were considered: predisposing factors, personality traits, Big Five model, self-esteem, self-presentation, interpersonal competency, social network site, Facebook, motivation, five-factor model, use, abuse, and addiction. Based on a defined list of inclusion and exclusion criteria, a total of 9 papers were finally included in the review. Results: Our findings identified 3 main personality traits to be of greater value: extraversion, neuroticism, and openness to experience. Extraversion was a good predictor of motivation and SNS use, whereas the latter trait showed relevance for age differences. All 3 features further played a role in gender differences. Apart from extraversion, the self-presentational motive was also related to narcissism, whereas the need to belong presented an association with agreeableness and neuroticism. Further underlining the social value behind SNS use, people perceived interpersonal competency as being related to Facebook use intensity. Conclusions: Extraversion was recognized as the main forerunner for SNS use and motivation for use. Neuroticism seems to be related to an attempt at compensating for difficulties in real-life social contexts. Openness to experiences has a strong valence for both adults and older adults since SNSs are still perceived as a novelty. Moreover, gender differences in SNS usage were observed to be the product of differences in motivation. Implications and limitations of the study were discussed. ",
doi="10.2196/12248",
url="http://formative.jmir.org/2019/2/e12248/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31199318"
}