@Article{info:doi/10.2196/13224,
author="Kool, Bridget
and Dobson, Rosie
and Sharpe, Sarah
and Humphrey, Gayl
and Whittaker, Robyn
and Ameratunga, Shanthi",
title="A Web-Based Alcohol Risk Communication Tool: Development and Pretesting Study",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="2",
volume="4",
number="1",
pages="e13224",
keywords="alcohol drinking",
keywords="risk assessment",
keywords="risk communication",
keywords="harm minimization, primary care",
abstract="Background: Alcohol use is a major public health concern associated with an increased risk of morbidity and mortality. Health professionals in primary care commonly see patients with a range of alcohol-related risks and problems, providing an ideal opportunity for screening and brief intervention (BI). Objective: This study aimed to develop a prototype for a Web-based tool for use by primary care health professionals (eg, doctors and nurses) to communicate alcohol harm risk to their patients and to engage with them regarding ways this risk could be reduced. Methods: Following conceptualization and development of prototype wireframes, formative work and pretesting were undertaken. For the formative work, focus groups and key informant interviews were conducted with potential end users of the risk communication tool, including health professionals and consumers. The focus groups and interviews explored perceptions of alcohol risk communication and obtained feedback on the initial prototype. For pretesting, participants (primary care doctors and nurses) completed a Web-based survey followed by a period of pretesting before completion of a follow-up survey. The study was designed to gain feedback on the tool's performance in real-world settings as well as its relevance, ease of use, and any suggested refinements. Results: In the formative work stage, 11 key informants and 7 consumers participated in either focus groups or individual interviews. Participants were very positive about the prototype and believed that it would be useful and acceptable in practice. Key informants identified that the key point of difference with the tool was that it provided all the pieces in 1 place (ie, assessment, interpretation, and resources to support change). Participants provided feedback on how the tool could be improved, and these suggestions were incorporated into the prototype where possible. In the pretesting stage, 7 people (5 doctors and 2 primary care nurses) completed the pretesting. Participants reported that the tool provided a useful framework for an intervention, that it would be acceptable to patients, that it was easy to use, that they would be likely to use it in practice, and that there were no technical issues. Conclusions: The alcohol risk communication tool was found to be acceptable and has the potential to increase the confidence of health professionals in assessing risk and providing BI. ",
doi="10.2196/13224",
url="https://formative.jmir.org/2020/1/e13224",
url="http://www.ncbi.nlm.nih.gov/pubmed/31895043"
}


@Article{info:doi/10.2196/16424,
author="Herbuela, Marquez Von Ralph Dane
and Karita, Tomonori
and Francisco, Ernesto Micanaldo
and Watanabe, Kozo",
title="An Integrated mHealth App for Dengue Reporting and Mapping, Health Communication, and Behavior Modification: Development and Assessment of Mozzify",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="8",
volume="4",
number="1",
pages="e16424",
keywords="dengue fever",
keywords="mHealth",
keywords="real-time surveillance",
keywords="health communication",
keywords="behavior modification",
abstract="Background: For the last 10 years, mobile phones have provided the global health community with innovative and cost-effective strategies to address the challenges in the prevention and management of dengue fever. Objective: The aim is to introduce and describe the design and development process of Mozzify, an integrated mobile health (mHealth) app that features real-time dengue fever case reporting and mapping system, health communication (real-time worldwide news and chat forum/timeline, within-app educational videos, links to local and international health agency websites, interactive signs and symptoms checker, and a hospital directions system), and behavior modification (reminders alert program on the preventive practices against dengue fever). We also aim to assess Mozzify in terms of engagement and information-sharing abilities, functionality, aesthetics, subjective quality, and perceived impact. Methods: The main goals of the Mozzify app were to increase awareness, improve knowledge, and change attitudes about dengue fever, health care-seeking behavior, and intention-to-change behavior on preventive practices for dengue fever among users. It was assessed using the Mobile Application Rating Scale (MARS) among 50 purposively sampled individuals: public health experts (n=5), environment and health-related researchers (n=23), and nonclinical (end users) participants (n=22). Results: High acceptability and excellent satisfaction ratings (mean scores ?4.0 out of 5) based on the MARS subscales indicate that the app has excellent user design, functionality, usability, engagement, and information among public health experts, environment and health-related researchers, and end users. The app's subjective quality (recommending the app to other people and the app's overall star rating), and specific quality (increase awareness, improve knowledge, and change attitudes about dengue fever; health care-seeking behavior; and intention-to-change behavior on preventive practices for dengue fever) also obtained excellent satisfaction ratings from the participants. Some issues and suggestions were raised during the focus group and individual discussions regarding the availability of the app for Android devices, language options limitations, provision of predictive surveillance, and inclusion of other mosquito-borne diseases. Conclusions: Mozzify may be a promising integrated strategic health intervention system for dengue fever case reporting and mapping; increase awareness, improve knowledge, and change attitude about dengue fever; and disseminating and sharing information on dengue fever among the general population and health experts. It also can be an effective aid in the successful translation of knowledge on preventive measures against dengue fever to practice. ",
doi="10.2196/16424",
url="https://formative.jmir.org/2020/1/e16424",
url="http://www.ncbi.nlm.nih.gov/pubmed/31913128"
}


@Article{info:doi/10.2196/13296,
author="Mohammadhassanzadeh, Hossein
and Sketris, Ingrid
and Traynor, Robyn
and Alexander, Susan
and Winquist, Brandace
and Stewart, Alan Samuel",
title="Using Natural Language Processing to Examine the Uptake, Content, and Readability of Media Coverage of a Pan-Canadian Drug Safety Research Project: Cross-Sectional Observational Study",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="14",
volume="4",
number="1",
pages="e13296",
keywords="natural language processing",
keywords="mass media",
keywords="readability",
keywords="pharmacoepidemiology",
keywords="knowledge translation",
abstract="Background: Isotretinoin, for treating cystic acne, increases the risk of miscarriage and fetal abnormalities when taken during pregnancy. The Health Canada--approved product monograph for isotretinoin includes pregnancy prevention guidelines. A recent study by the Canadian Network for Observational Drug Effect Studies (CNODES) on the occurrence of pregnancy and pregnancy outcomes during isotretinoin therapy estimated poor adherence to these guidelines. Media uptake of this study was unknown; awareness of this uptake could help improve drug safety communication. Objective: The aim of this study was to understand how the media present pharmacoepidemiological research using the CNODES isotretinoin study as a case study. Methods: Google News was searched (April 25-May 6, 2016), using a predefined set of terms, for mention of the CNODES study. In total, 26 articles and 3 CNODES publications (original article, press release, and podcast) were identified. The article texts were cleaned (eg, advertisements and links removed), and the podcast was transcribed. A dictionary of 1295 unique words was created using natural language processing (NLP) techniques (term frequency-inverse document frequency, Porter stemming, and stop-word filtering) to identify common words and phrases. Similarity between the articles and reference publications was calculated using Euclidian distance; articles were grouped using hierarchical agglomerative clustering. Nine readability scales were applied to measure text readability based on factors such as number of words, difficult words, syllables, sentence counts, and other textual metrics. Results: The top 5 dictionary words were pregnancy (250 appearances), isotretinoin (220), study (209), drug (201), and women (185). Three distinct clusters were identified: Clusters 2 (5 articles) and 3 (4 articles) were from health-related websites and media, respectively; Cluster 1 (18 articles) contained largely media sources; 2 articles fell outside these clusters. Use of the term isotretinoin versus Accutane (a brand name of isotretinoin), discussion of pregnancy complications, and assignment of responsibility for guideline adherence varied between clusters. For example, the term pregnanc appeared most often in Clusters 1 (14.6 average times per article) and 2 (11.4) and relatively infrequently in Cluster 3 (1.8). Average readability for all articles was high (eg, Flesch-Kincaid, 13; Gunning Fog, 15; SMOG Index, 10; Coleman Liau Index, 15; Linsear Write Index, 13; and Text Standard, 13). Readability increased from Cluster 2 (Gunning Fog of 16.9) to 3 (12.2). It varied between clusters (average 13th-15th grade) but exceeded the recommended health information reading level (grade 6th to 8th), overall. Conclusions: Media interpretation of the CNODES study varied, with differences in synonym usage and areas of focus. All articles were written above the recommended health information reading level. Analyzing media using NLP techniques can help determine drug safety communication effectiveness. This project is important for understanding how drug safety studies are taken up and redistributed in the media. ",
doi="10.2196/13296",
url="https://formative.jmir.org/2020/1/e13296",
url="http://www.ncbi.nlm.nih.gov/pubmed/31934872"
}


@Article{info:doi/10.2196/16652,
author="Bricker, B. Jonathan
and Watson, L. Noreen
and Heffner, L. Jaimee
and Sullivan, Brianna
and Mull, Kristin
and Kwon, Diana
and Westmaas, Lee Johann
and Ostroff, Jamie",
title="A Smartphone App Designed to Help Cancer Patients Stop Smoking: Results From a Pilot Randomized Trial on Feasibility, Acceptability, and Effectiveness",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="17",
volume="4",
number="1",
pages="e16652",
keywords="smartphone app",
keywords="mHealth",
keywords="tobacco",
keywords="smoking",
keywords="cancer patient",
abstract="Background: Persistent smoking after a cancer diagnosis predicts worse treatment outcomes and mortality, but access to effective smoking cessation interventions is limited. Smartphone apps can address this problem by providing a highly accessible, low-cost smoking cessation intervention designed for patients with a recent cancer diagnosis. Objective: This study aimed to summarize our development process and report the trial design, feasibility, participant acceptability, preliminary effectiveness, and impact on processes of change (eg, cancer stigma) of the first-known smoking cessation smartphone app targeted for cancer patients. Methods: We used an agile, user-centered design framework to develop a fully automated smartphone app called Quit2Heal that provided skills training and stories from cancer survivors focusing on coping with internalized shame, cancer stigma, depression, and anxiety as core triggers of smoking. Quit2Heal was compared with the National Cancer Institute's QuitGuide, a widely used stop smoking app for the general population, in a pilot double-blinded randomized trial with a 2-month follow-up period. Participants were 59 adult smokers diagnosed with cancer within the past 12 months and recruited through 2 cancer center care networks and social media over a 12-month period. The most common types of cancer diagnosed were lung (21/59, 36\%) and breast (10/59, 17\%) cancers. The 2-month follow-up survey retention rate was 92\% (54/59) and did not differ by study arm (P=.15). Results: Compared with QuitGuide participants, Quit2Heal participants were more satisfied with their assigned app (90\% [19/21] for Quit2Heal vs 65\% [17/26] for QuitGuide; P=.047) and were more likely to report that the app assigned to them was made for someone like them (86\% [18/21] for Quit2Heal vs 62\% [16/26] for QuitGuide; P=.04). Quit2Heal participants opened their app a greater number of times during the 2-month trial period, although this difference was not statistically significant (mean 10.0, SD 14.40 for Quit2Heal vs mean 6.1, SD 5.3 for QuitGuide; P=.33). Self-reported 30-day point prevalence quit rates at the 2-month follow-up were 20\% (5/25) for Quit2Heal versus 7\% (2/29) for QuitGuide (odds ratio 5.16, 95\% CI 0.71-37.29; P=.10). Quit2Heal participants also showed greater improvement in internalized shame, cancer stigma, depression, and anxiety, although these were not statistically significant (all P>.05). Conclusions: In a pilot randomized trial with a high short-term retention rate, Quit2Heal showed promising acceptability and effectiveness for helping cancer patients stop smoking. Testing in a full-scale randomized controlled trial with a longer follow-up period and a larger sample size is required to test the effectiveness, mediators, and moderators of this promising digital cessation intervention. Trial Registration: ClinicalTrials.gov NCT03600038; https://clinicaltrials.gov/ct2/show/NCT03600038 ",
doi="10.2196/16652",
url="http://formative.jmir.org/2020/1/e16652/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31951215"
}


@Article{info:doi/10.2196/14780,
author="St{\o}me, Nathalie Linn
and Moger, Tron
and Kidholm, Kristian
and Kv{\ae}rner, J. Kari",
title="A Web-Based Communication Platform to Improve Home Care Services in Norway (DigiHelse): Pilot Study",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="20",
volume="4",
number="1",
pages="e14780",
keywords="early health technology assessment",
keywords="eHealth",
keywords="primary care",
keywords="innovation",
keywords="behavioral data",
abstract="Background: Home care service in Norway is struggling to meet the increasing demand for health care under restricted budget constraints, although one-fourth of municipal budgets are dedicated to health services. The integration of Web-based technology in at-home care is expected to enhance communication and patient involvement, increase efficiency and reduce cost. DigiHelse is a Web-based platform designed to reinforce home care service in Norway and is currently undergoing a development process to meet the predefined needs of the country's municipalities. Some of the main features of the platform are digital messages between residents and the home care service, highlighting information on planned and completed visits, the opportunity to cancel visits, and notifications for completed visits. Objective: This study aimed to test the usability and economic feasibility of adopting DigiHelse in four districts in Oslo by applying registry and behavioral data collected throughout a one-year pilot study. Early health technology assessment was used to estimate the potential future value of DigiHelse, including the predictive value of behavior data. Methods: Outcome measures identified by stakeholder insights and scenario drafting in the project's concept phase were used to assess potential socioeconomic benefits. Aggregated data were collected to assess changes in health consumption at baseline, and then 15 and 52 weeks after DigiHelse was implemented. The present value calculation was updated with data from four intervention groups and one control group. A quasi-experimental difference-in-difference design was applied to estimate the causal effect. Descriptive behavioral data from the digital platform was applied to assess the usability of the platform. Results: Over the total study period (52 weeks), rates increased for all outcome estimates: the number of visits (rate ratio=1.04; P=.10), unnecessary trips (rate ratio=1.37; P=.26), and phone calls (rate ratio=1.24; P=.08). A significant gap was found between the estimated value of DigiHelse in the concept phase and after the one-year pilot. In the present pilot assessment, costs are expected to exceed potential savings by {\texteuro}67 million (US \$75 million) over ten years, as compared to the corresponding concept estimates of a potential gain of {\texteuro}172.6 million (US \$193.6 million). Interestingly, behavioral data from the digital platform revealed that only 3.55\% (121/3405) of recipients actively used the platform after one year. Conclusions: Behavioral data provides a valuable source for assessing usability. In this pilot study, the low adoption rate may, at least in part, explain the inability of DigiHelse to perform as expected. This study points to an early assessment of behavioral data as an opportunity to identify inefficiencies and direct digital development. For DigiHelse, insight into why the recipients in Oslo have not made greater use of the Web-based platform seems to be the next step in ensuring the right improvement measures for the home care service. ",
doi="10.2196/14780",
url="http://formative.jmir.org/2020/1/e14780/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31958062"
}


@Article{info:doi/10.2196/12538,
author="Middelweerd, Anouk
and Mollee, Julia
and Klein, MCA Michel
and Manzoor, Adnan
and Brug, Johannes
and te Velde, J. Saskia",
title="The Use and Effects of an App-Based Physical Activity Intervention ``Active2Gether'' in Young Adults: Quasi-Experimental Trial",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="21",
volume="4",
number="1",
pages="e12538",
keywords="physical activity",
keywords="smartphone",
keywords="mobile app",
abstract="Background: Insufficient physical activity (PA) is highly prevalent and associated with adverse health conditions and the risk of noncommunicable diseases. To increase levels of PA, effective interventions to promote PA are needed. Present-day technologies such as smartphones, smartphone apps, and activity trackers offer several possibilities in health promotion. Objective: This study aimed to explore the use and short-term effects of an app-based intervention (Active2Gether) to increase the levels of PA in young adults. Methods: Young adults aged 18-30 years were recruited (N=104) using diverse recruitment strategies. The participants were allocated to the Active2Gether-Full condition (tailored coaching messages, self-monitoring, and social comparison), Active2Gether-Light condition (self-monitoring and social comparison), and the Fitbit-only control condition (self-monitoring). All participants received a Fitbit One activity tracker, which could be synchronized with the intervention apps, to monitor PA behavior. A 12-week quasi-experimental trial was conducted to explore the intervention effects on weekly moderate-to-vigorous PA (MVPA) and relevant behavioral determinants (ie, self-efficacy, outcome expectations, social norm, intentions, satisfaction, perceived barriers, and long-term goals). The ActiGraph wGT3XBT and GT3X+ were used to assess baseline and postintervention follow-up PA. Results: Compared with the Fitbit condition, the Active2Gether-Light condition showed larger effect sizes for minutes of MVPA per day (regression coefficient B=3.1; 95\% CI ?6.7 to 12.9), and comparatively smaller effect sizes were seen for the Active2Gether-Full condition (B=1.2; 95\% CI ?8.7 to 11.1). Linear and logistic regression analyses for the intervention effects on the behavioral determinants at postintervention follow-up showed no significant intervention effects of the Active2Gether-Full and Active2Gether-Light conditions. The overall engagement with the Fitbit activity tracker was high (median 88\% (74/84) of the days), but lower in the Fitbit condition. Participants in the Active2Gether conditions reported more technical problems than those in the Fitbit condition. Conclusions: This study showed no statistically significant differences in MVPA or determinants of MVPA after exposure to the Active2Gether-Full condition compared with the Active2Gether-Light or Fitbit condition. This might partly be explained by the small sample size and the low rates of satisfaction in the participants in the two Active2Gether conditions that might be because of the high rates of technical problems. ",
doi="10.2196/12538",
url="http://formative.jmir.org/2020/1/e12538/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31961330"
}


@Article{info:doi/10.2196/12618,
author="Doty, L. Jennifer
and Brady, S. Sonya
and Monardez Popelka, Javiera
and Rietveld, Laura
and Garcia-Huidobro, Diego
and Doty, J. Matthew
and Linares, Roxana
and Svetaz, Veronica Maria
and Allen, L. Michele",
title="Designing a Mobile App to Enhance Parenting Skills of Latinx Parents: A Community-Based Participatory Approach",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="24",
volume="4",
number="1",
pages="e12618",
keywords="mobile application",
keywords="eHealth",
keywords="community-based participatory research",
keywords="Hispanic Americans, family",
abstract="Background: Latinx families are among the highest users of smartphones, yet few health-focused Web programs have been developed for this audience. Parent-based smartphone apps designed for Latinx families may help increase access to evidence-informed parenting programming and ultimately reduce health disparities among children and adolescents. To maximize uptake of such apps, the Center for eHealth Research and Disease Management (CeHRes) Roadmap for electronic health (eHealth) development recommends 5 phases of development: (1) contextual inquiry, (2) value specification, (3) design, (4) operationalization, and (5) evaluation. Objective: Guided by the CeHRes Roadmap, our objective was to apply a community-based participatory research (CBPR) approach to mobile app development. We present a formative evaluation to inform the design of an eHealth mobile app for Latinx parents of adolescents based on a face-to-face parenting program, Padres Informados/Jovenes Preparados (PIJP). Methods: Community participants in the process included Latinx parents and stakeholders. We conducted a parent survey (N=115) and interviews (N=20) to understand the context and obtain feedback on a mockup and prototype of the app, facilitator workshops to streamline content, and stakeholder interviews (N=4) to discuss values and app requirements. Results: We report results from the first 3 phases of the CeHRes Roadmap. In the survey, 96.5\% (111/115) of parents reported they had access to a cell phone, 85.6\% (89/104) reported they would use a parenting app in the next month if they had access, and 80.2\% (89/111) reported intentions to use a stress reduction app. Parents reported that setting goals about parenting and tracking those goals were important potential features of an app. In logistic regression analyses, technology attitudes and barriers were not related to parent's intentions to use a parenting mobile app (95\% CI 0.51-1.17 and 95\% CI 0.28-2.12, respectively). Qualitative interviews confirmed Latinx parents' technology engagement and desire for education and child development information online. Stakeholder interviews identified 3 community values: familism, the promotion of adolescent health, and delivery of economic value. Community stakeholders participated in defining the mobile app requirements. On the basis of community and parent input, the mobile app prototype was designed with 3 sections: (1) 8 modules of video-based parenting skills instruction with content from the face-to-face PIJP program, (2) breath rate information from a wearable device to support awareness of stress levels that could affect parenting, and (3) goal setting and tracking capacities. Conclusions: The findings of this study highlight the utility of an iterative, participatory design process. The CBPR approach and community collaboration enhanced the CeHRes Roadmap by promoting power sharing, facilitating recruitment, and building trust among community members. Experiences applying community research to the initial 3 phases of the CeHRes Roadmap in a Latinx community are discussed, along with plans for the 2 final phases. ",
doi="10.2196/12618",
url="https://formative.jmir.org/2020/1/e12618",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012034"
}


@Article{info:doi/10.2196/13207,
author="Vasilica, Mihaela Cristina
and Brettle, Alison
and Ormandy, Paula",
title="A Co-Designed Social Media Intervention to Satisfy Information Needs and Improve Outcomes of Patients With Chronic Kidney Disease: Longitudinal Study",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="27",
volume="4",
number="1",
pages="e13207",
keywords="social media",
keywords="patients outcomes",
keywords="long term condition",
keywords="chronic kidney disease",
keywords="self-efficacy",
keywords="patients information needs",
keywords="co-design",
abstract="Background: The number of people living with a long-term condition is increasing worldwide. Social media offers opportunities for patients to exchange information and experiences with others with the same condition, potentially leading to better self-management and improved patient outcomes, at minimal costs to health service providers. Objective: This paper describes how an online network with a range of social media platforms was created, with the help of a group of patients with chronic kidney disease and specialist professionals. The project considered whether information needs and health-related and social outcomes were met. Methods: We performed a longitudinal in-depth evaluation of the creation of the moderated network, observation of the use of the platforms, self-efficacy surveys (at baseline and 6 months), and semistructured interviews (at baseline and 6 months). Results: A total of 15 patients and professionals participated in the co-design of the network (hub), which was initially launched with 50 patients. Several platforms were needed to engage patients at different levels and encourage generation of information, with the support of moderators. In addition, 14 separate patients participated in the evaluation. Satisfaction of information needs through social engagement improved self-efficacy (n=13) with better self-care and management of illness. Social outcomes included seeking employment and an increase in social capital. Conclusions: An online network (hub) with several social media platforms helped patients with chronic kidney disease manage their condition. Careful co-designing with users resulted in a sustainable network with wider applicability across health and social care. ",
doi="10.2196/13207",
url="https://formative.jmir.org/2020/1/e13207",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012040"
}


@Article{info:doi/10.2196/12917,
author="Nielsen, Anna
and B{\aa}genholm, Aspasia
and De Costa, Ayesha",
title="Development of a Mobile Phone App to Promote Safe Sex Practice Among Youth in Stockholm, Sweden: Qualitative Study",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="28",
volume="4",
number="1",
pages="e12917",
keywords="mHealth",
keywords="youth",
keywords="sexual health",
keywords="condoms",
keywords="Sweden",
abstract="Background: Mobile health (mHealth) has been shown to be effective in increasing knowledge of sexual health among youth. To date, evaluations mostly refer to interventions delivered via computer, email, and text messages. The possibility of downloading apps on mobile devices has opened up opportunities to develop engaging interventions on safe sexual health promotion. To attract young users and have them engage with a sexual health app, it is important to involve youth in intervention development. Objective: This study aimed to obtain input from youth on the content of a mobile phone app intended to promote safe sex and increase condom use among youth in Stockholm. Methods: This study was conducted at the Youth Health Clinics (YHC) in Stockholm County, Sweden. A total of 15 individual in-depth interviews and 2 focus group discussions (with youth aged 18-23 years) were conducted at the YHC in Stockholm. Areas explored were: (1) youth perceptions of condom use (advantages and obstacles), (2) perceptions of mHealth to promote safe sexual practices, and (3) content development for a mobile phone app to promote safe sex. Results: The smartphone app was developed based on the categories that emerged from the data. With regard to content, youth requested sex education, including information on sexually transmitted infections. In addition, condom-specific information, including practical usage technique, advice on how to have the condom talk, and how to decrease shame related to condom use, was requested. Youth suggested different modes to deliver the content, including text messages, movie clips, and push notifications. It was suggested that the tone of the messages delivered should be fun, entertaining, and supportive. The inputs from youth influenced the development of the following sections of the app: Condom Obstacles and Solutions; Quiz; Games; Self-Refection; Challenges; Stories by Peers (stories from peers and information from a doctor); Condom Tips, Pep Talk, and Boosting; and Random Facts. Conclusions: It is important to use input from youth when developing a smartphone intervention since the success of the intervention largely depends on the level of engagement and usage by youth. Furthermore, if proven efficient in increasing condom use, it is important that the development, including content and mode, is thoroughly described so that the intervention can be replicated. Likewise, if proven inefficient, it is important to learn from mistakes to improve and adjust the intervention. The effect of this smartphone app on safe sexual practices among youth is being evaluated in a pragmatic randomized controlled trial in Stockholm (ISRCTN13212899) and will be reported separately. ",
doi="10.2196/12917",
url="https://formative.jmir.org/2020/1/e12917",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012038"
}


@Article{info:doi/10.2196/14111,
author="Kim, Minjin
and Lee, Haeok
and Allison, Jeroan",
title="Challenges and Lessons Learned From a Mobile Health, Web-Based Human Papillomavirus Intervention for Female Korean American College Students: Feasibility Experimental Study",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="29",
volume="4",
number="1",
pages="e14111",
keywords="mHealth",
keywords="Web-based intervention",
keywords="fraud",
keywords="experimental design",
abstract="Background: Mobile health (mHealth) and Web-based research methods are becoming more commonplace for researchers. However, there is a lack of mHealth and Web-based human papillomavirus (HPV) prevention experimental studies that discuss potential issues that may arise. Objective: This study aimed to assess the feasibility of research procedures and discuss the challenges and lessons learned from an mHealth and Web-based HPV prevention experimental study targeting female Korean American college students in the United States. Methods: A pilot randomized controlled trial (RCT) was conducted in an mHealth and Web-based platform with 104 female Korean American college students aged 18-26 years between September 2016 and December 2016. Participants were randomized to either the experimental group (a storytelling video intervention) or the comparison group (a nonnarrative, information-based intervention). Outcomes included the feasibility of research procedures (recruitment, eligibility, randomization, and retention). Results: From September 2016 to October 2016, we recorded 225 entries in our initial eligibility survey. The eligibility rate was 54.2\% (122/225). This study demonstrated a high recruitment rate (95.6\%, 111/122) and retention rate (83.7\%, 87/104) at the 2-month follow-up. Conclusions: Findings from this study demonstrated sufficient feasibility in terms of research procedures to justify a full-scale RCT. Given the increased possibility of invalid or misrepresentative entries in mHealth and Web-based studies, strategies for detection and prevention are critical. Trial Registration: ISRCTN Registry ISRCTN12175285;?http://www.isrctn.com/ISRCTN12175285 ",
doi="10.2196/14111",
url="http://formative.jmir.org/2020/1/e14111/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012036"
}


@Article{info:doi/10.2196/13495,
author="Step, M. Mary
and McMillen Smith, Jennifer
and Kratz, Joshua
and Briggs, Julia
and Avery, Ann",
title="``Positive Peers'': Function and Content Development of a Mobile App for Engaging and Retaining Young Adults in HIV Care",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="30",
volume="4",
number="1",
pages="e13495",
keywords="HIV",
keywords="young adults",
keywords="mobile applications",
keywords="self-management",
abstract="Background: Although treatment for HIV infection is widely available and well tolerated, less than 30\% of adolescents and young adults living with HIV infection achieve stable viral suppression. Mobile technology affords increased opportunities for young people living with HIV to engage with information, health management tools, and social connections that can support adherence to treatment recommendations and medication. Although mobile apps are increasingly prevalent, few are informed by the target population. Objective: The objective of this study was to describe the ``Positive Peers'' app, a mobile app currently being evaluated in a public hospital in the Midwestern United States. Formative development, key development strategies, user recruitment, and lessons learned are discussed in this paper. Methods: ``Positive Peers'' was developed in collaboration with a community advisory board (CAB) comprising in-care young adults living with HIV and a multidisciplinary project team. Mobile app functions and features were developed over iterative collaborative sessions that were tailored to the CAB members. In turn, the CAB built rapport with the project team and revealed unique information that was used in app development. Results: The study was funded on September 1, 2015; approved by the MetroHealth Institutional Review Board on August 31, 2016; and implemented from October 11, 2016, to May 31, 2019. The ``Positive Peers'' mobile app study has enrolled 128 users who reflect priority disparity population subgroups. The app administrator had frequent contact with users across app administration and study-related activities. Key lessons learned from the study include changing privacy concerns, data tracking reliability, and user barriers. Intermediate and outcome variable evaluation is expected in October 2019. Conclusions: Successful development of the ``Positive Peers'' mobile app was supported by multidisciplinary expertise, an enthusiastic CAB, and a multifaceted, proactive administrator. ",
doi="10.2196/13495",
url="http://formative.jmir.org/2020/1/e13495/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012035"
}


@Article{info:doi/10.2196/13197,
author="Pekmezaris, Renee
and Kozikowski, Andrzej
and Pascarelli, Briana
and Wolf-Klein, Gisele
and Boye-Codjoe, Eugenia
and Jacome, Sonia
and Madera, Danielle
and Tsang, Donna
and Guerrero, Brenda
and Medina, Richard
and Polo, Jennifer
and Williams, Myia
and Hajizadeh, Negin",
title="A Telehealth-Delivered Pulmonary Rehabilitation Intervention in Underserved Hispanic and African American Patients With Chronic Obstructive Pulmonary Disease: A Community-Based Participatory Research Approach",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="31",
volume="4",
number="1",
pages="e13197",
keywords="COPD",
keywords="pulmonary rehabilitation",
keywords="telehealth",
keywords="CPBR",
keywords="disparities",
keywords="telemonitoring",
abstract="Background: Although home telemonitoring (TM) is a promising approach for patients managing their chronic disease, rehabilitation using home TM has not been tested for use with individuals living with chronic obstructive pulmonary disease (COPD) residing in underserved communities. Objective: This study aimed to analyze qualitative data from focus groups with key stakeholders to ensure the acceptability and usability of the TM COPD intervention. Methods: We utilized a community-based participatory research (CBPR) approach to adapt a home TM COPD intervention to facilitate acceptability and feasibility in low-income African American and Hispanic patients. The study engaged community stakeholders in the process of modifying the intervention in the context of 2 community advisory board meetings. Discussions were audio recorded and professionally transcribed and lasted approximately 2 hours each. Structural coding was used to mark responses to topical questions in interview guides. Results: We describe herein the formative process of a CBPR study aimed at optimizing telehealth utilization among African American and Latino patients with COPD from underserved communities. A total of 5 major themes emerged from qualitative analyses of community discussions: equipment changes, recruitment process, study logistics, self-efficacy, and access. The identification of themes was instrumental in understanding the concerns of patients and other stakeholders in adapting the pulmonary rehabilitation (PR) home intervention for acceptability for patients with COPD from underserved communities. Conclusions: These findings identify important adaptation recommendations from the stakeholder perspective that should be considered when implementing in-home PR via TM for underserved COPD patients. Trial Registration: ClinicalTrials.gov NCT03007485; https://clinicaltrials.gov/ct2/show/NCT03007485 ",
doi="10.2196/13197",
url="https://formative.jmir.org/2020/1/e13197",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012039"
}


@Article{info:doi/10.2196/17077,
author="Kedroske, Jacob
and Koblick, Sarah
and Chaar, Dima
and Mazzoli, Amanda
and O'Brien, Maureen
and Yahng, Lilian
and Vue, Rebecca
and Chappell, Grant
and Shin, Youn Ji
and Hanauer, A. David
and Choi, Won Sung",
title="Development of a National Caregiver Health Survey for Hematopoietic Stem Cell Transplant: Qualitative Study of Cognitive Interviews and Verbal Probing",
journal="JMIR Form Res",
year="2020",
month="Jan",
day="23",
volume="4",
number="1",
pages="e17077",
keywords="hematopoietic stem cell transplantation",
keywords="caregivers",
keywords="mobile applications",
keywords="qualitative research",
abstract="Background: Roadmap 1.0 is a mobile health app that was previously developed for caregivers of patients who have undergone hematopoietic stem cell transplantation (HSCT). Formative research targeted toward its end users (caregivers) can help inform app design and development, allowing additional components to be incorporated into the app, which can then be tested in a future randomized controlled trial. Objective: This study aimed to create a methodologically rigorous national survey that would help inform the development of Roadmap 2.0. Methods: We conducted a prospective, qualitative research study that took place between November 18, 2018, and February 7, 2019, in a blood and marrow transplant unit within a large academic medical institution in the midwestern part of the United States. Cognitive interviews, including think-aloud and verbal probing techniques, were conducted in 10 adult caregivers (?18 years) of patients who had undergone HSCT. Results: Most participants were female (9/10, 90\%), white (9/10, 90\%), married (9/10, 90\%), employed at least part time (6/10, 60\%), caregivers of adult patients (7/10, 70\%), and had some college education (9/10, 90\%) and an annual household income of \$60,000 or higher (6/10, 60\%). All but one interview was audio-recorded, with permission. Overall, participants were engaged in the cognitive interview process of the draft survey, which included 7 topics. The interviews highlighted areas wherein survey items could be further refined, such as offering more response choices (eg, ``NA'') or clarifying the type of transplant (eg, autologous or allogeneic) or context of transplant care (eg, pre-HSCT, during HSCT, post-HSCT, inpatient, and outpatient). Apart from these findings, the items in demographics, caregiving experiences, technology, positive activities, and mood were generally interpreted as intended. On the basis of the transcript data and field notes by the interviewer, items within self-efficacy (Caregiver Self-Efficacy Scale) and coping (Brief Coping Orientation to Problems Experienced inventory) questionnaires generated more confusion among interviewer and participants, reflecting difficulties in interpreting the meaning of some survey items. Conclusions: This study incorporated the four cognitive aspects of survey methodology that describe the question-answering process---(1) comprehension, (2) information retrieval, (3) judgment and decision making, and (4) responding---by using the think-aloud and probing techniques in cognitive interviews. We conclude that this methodologically rigorous process informed revisions and improved our final questionnaire design. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.49188 ",
doi="10.2196/17077",
url="http://formative.jmir.org/2020/1/e17077/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32012037"
}