@Article{info:doi/10.2196/20325,
author="Liu, Mandong
and Jiang, Tongge
and Yu, Kexin
and Wu, Shinyi
and Jordan-Marsh, Maryalice
and Chi, Iris",
title="Care Me Too, a Mobile App for Engaging Chinese Immigrant Caregivers in Self-Care: Qualitative Usability Study",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="2",
volume="4",
number="12",
pages="e20325",
keywords="mHealth",
keywords="co-design",
keywords="usability",
keywords="acceptability",
keywords="immigrant",
keywords="caregiver",
keywords="mobile phone",
abstract="Background: Caregiving and self-care are challenging for Chinese immigrants in the United States due to limited accessible support and resources. Few interventions exist to assist Chinese immigrant caregivers in better performing self-care. To address this gap in the literature, our team developed the Care Me Too app to engage Chinese immigrant caregivers in self-care and conducted a user experience test to assess its usability and acceptability. Objective: This paper aims to report the results of the app's usability and acceptability testing with Chinese immigrant caregivers and to solicit participants' feedback of the app design and functions. Methods: A total of 22 Mandarin-speaking Chinese caregivers participated in the study, which consisted of 2 parts: the in-lab testing and the 1-week at-home testing. In-depth face-to-face interviews and follow-up phone interviews were used to assess user experience of the app's usability and acceptability and to solicit feedback for app design and functions. Directed content analysis was used to analyze the qualitative data. Results: Among the 22 participants, the average age was 60.5 (SD 8.1) years, ranging from 46 to 80 years; 17 (77\%) participants were women and 14 (64\%) had an associate degree or higher. Participants reported uniformly positive ratings of the usability and acceptability of the app and provided detailed suggestions for app improvement. We generated guidelines for mobile health (mHealth) app designs targeting immigrant caregivers, including weighing flexibility versus majority preferences, increasing text sizes, using colors effectively, providing engaging and playful visual designs and functions, simplifying navigation, simplifying the log-in process, improving access to and the content on the help document, designing functions to cater to the population's context, and ensuring offline access. Conclusions: The main contribution of this study is the improved understanding of Chinese caregivers' user experiences with a language-appropriate mHealth app for a population that lacks accessible caregiving and self-care resources and support. It is recommended that future researchers and app designers consider the proposed guidelines when developing mHealth apps for their population to enhance user experience and harness mHealth's value. ",
doi="10.2196/20325",
url="https://formative.jmir.org/2020/12/e20325",
url="http://www.ncbi.nlm.nih.gov/pubmed/33263552"
}


@Article{info:doi/10.2196/21671,
author="Tweheyo, Raymond
and Selig, Hannah
and Gibson, G. Dustin
and Pariyo, William George
and Rutebemberwa, Elizeus",
title="User Perceptions and Experiences of an Interactive Voice Response Mobile Phone Survey Pilot in Uganda: Qualitative Study",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="3",
volume="4",
number="12",
pages="e21671",
keywords="interactive voice response",
keywords="noncommunicable diseases",
keywords="qualitative",
keywords="Uganda",
abstract="Background: With the growing burden of noncommunicable diseases in low- and middle- income countries, the World Health Organization recommended a stepwise approach of surveillance for noncommunicable diseases. This is expensive to conduct on a frequent basis and using interactive voice response mobile phone surveys has been put forth as an alternative. However, there is limited evidence on how to design and deliver interactive voice response calls that are robust and acceptable to respondents. Objective: This study aimed to explore user perceptions and experiences of receiving and responding to an interactive voice response call in Uganda in order to adapt and refine the instrument prior to national deployment. Methods: A qualitative study design was used and comprised a locally translated audiorecorded interactive voice response survey delivered in 4 languages to 59 purposively selected participants' mobile phones in 5 survey rounds guided by data saturation. The interactive voice response survey had modules on sociodemographic characteristics, physical activity, fruit and vegetable consumption, diabetes, and hypertension. After the interactive voice response survey, study staff called participants back and used a semistructured interview to collect information on the participant's perceptions of interactive voice response call audibility, instruction clarity, interview pace, language courtesy and appropriateness, the validity of questions, and the lottery incentive. Descriptive statistics were used for the interactive voice response survey, while a framework analysis was used to analyze qualitative data. Results: Key findings that favored interactive voice response survey participation or completion included preference for brief surveys of 10 minutes or shorter, preference for evening calls between 6 PM and 10 PM, preference for courteous language, and favorable perceptions of the lottery-type incentive. While key findings curtailing participation were suspicion about the caller's identity, unclear voice, confusing skip patterns, difficulty with the phone interface such as for selecting inappropriate digits for both ordinary and smartphones, and poor network connectivity for remote and rural participants. Conclusions: Interactive voice response surveys should be as brief as possible and considerate of local preferences to increase completion rates. Caller credibility needs to be enhanced through either masking the caller or prior community mobilization. There is need to evaluate the preferred timing of interactive voice response calls, as the finding of evening call preference is inconclusive and might be contextual. ",
doi="10.2196/21671",
url="https://formative.jmir.org/2020/12/e21671",
url="http://www.ncbi.nlm.nih.gov/pubmed/33270037"
}


@Article{info:doi/10.2196/19863,
author="McEntee, L. Mindy
and Cantley, Alison
and Foreman, Emily
and Berardi, Vincent
and Phillips, B. Christine
and Hurley, C. Jane
and Hovell, F. Melbourne
and Hooker, Steven
and Adams, A. Marc",
title="Effects of Goal Type and Reinforcement Type on Self-Reported Domain-Specific Walking Among Inactive Adults: 2{\texttimes}2 Factorial Randomized Controlled Trial",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="4",
volume="4",
number="12",
pages="e19863",
keywords="exercise",
keywords="population health",
keywords="goals",
keywords="reward",
keywords="walking",
keywords="mHealth",
keywords="health promotion",
keywords="health behavior",
keywords="adaptive intervention",
keywords="behavioral intervention",
abstract="Background: WalkIT Arizona was a 2{\texttimes}2 factorial trial examining the effects of goal type (adaptive versus static) and reinforcement type (immediate versus delayed) to increase moderate to vigorous physical activity (MVPA) among insufficiently active adults. The 12-month intervention combined mobile health (mHealth) technology with behavioral strategies to test scalable population-health approaches to increasing MVPA. Self-reported physical activity provided domain-specific information to help contextualize the intervention effects. Objective: The aim of this study was to report on the secondary outcomes of self-reported walking for transportation and leisure over the course of the 12-month WalkIT intervention. Methods: A total of 512 participants aged 19 to 60 years (n=330 [64.5\%] women; n=425 [83\%] Caucasian/white, n=96 [18.8\%] Hispanic/Latinx) were randomized into interventions based on type of goals and reinforcements. The International Physical Activity Questionnaire-long form assessed walking for transportation and leisure at baseline, and at 6 months and 12 months of the intervention. Negative binomial hurdle models were used to examine the effects of goal and reinforcement type on (1) odds of reporting any (versus no) walking/week and (2) total reported minutes of walking/week, adjusted for neighborhood walkability and socioeconomic status. Separate analyses were conducted for transportation and leisure walking, using complete cases and multiple imputation. Results: All intervention groups reported increased walking at 12 months relative to baseline. Effects of the intervention differed by domain: a significant three-way goal by reinforcement by time interaction was observed for total minutes of leisure walking/week, whereas time was the only significant factor that contributed to transportation walking. A sensitivity analysis indicated minimal differences between complete case analysis and multiple imputation. Conclusions: This study is the first to report differential effects of adaptive versus static goals for self-reported walking by domain. Results support the premise that individual-level PA interventions are domain- and context-specific and may be helpful in guiding further intervention refinement. Trial Registration: Preregistered at clinicaltrials.gov: (NCT02717663) https://clinicaltrials.gov/ct2/show/NCT02717663 International Registered Report Identifier (IRRID): RR2-10.1016/j.cct.2019.05.001 ",
doi="10.2196/19863",
url="https://formative.jmir.org/2020/12/e19863",
url="http://www.ncbi.nlm.nih.gov/pubmed/33275107"
}


@Article{info:doi/10.2196/14344,
author="Hindson, Josephine
and Hanstock, Tanya
and Dunlop, Adrian
and Kay-Lambkin, Frances",
title="Internet-Delivered Tobacco Treatment for People Using Cannabis: A Randomized Trial in Two Australian Cannabis Clinics",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="7",
volume="4",
number="12",
pages="e14344",
keywords="tobacco",
keywords="cannabis",
keywords="help-seeking behavior",
keywords="internet-based intervention",
abstract="Background: Tobacco use is disproportionately higher in people who smoke cannabis than in the general population, increasing the severity of dependence for cannabis use, decreasing the likelihood of successful quit attempts for both cannabis and tobacco, and increasing the risk of relapse for both substances. Opportunities to address tobacco use in people using cannabis are being missed. Objective: This study aims to investigate the feasibility of engaging tobacco smokers who were accessing treatment for cannabis, with a tobacco-focused internet-based Healthy Lifestyle Program (iHeLP; 4 modules). It was hypothesized that iHeLP completion would be associated with decreases in tobacco use and improved quality of life (QoL) and psychological health. It was also hypothesized that iHeLP completion would be higher in those who additionally received telephone support. Given that iHeLP aimed to improve healthy lifestyle behaviors, it was also hypothesized that there would be reductions in cannabis use. Methods: A total of 13 smokers seeking treatment for cannabis use were randomly allocated to iHeLP alone or iHeLP plus telephone support. Participants were engaged in iHeLP over 8 weeks and completed a 12-week follow-up assessment. Results: Results from 10 participants who completed the follow-up indicated that the acceptability of iHeLP was high-very high in terms of general satisfaction, appropriateness of services, effectiveness, and met need. Additional telephone support increased modal module completion rates for iHeLP from 0 to 2 but did not provide any other significant advantages over iHeLP alone in terms of cannabis use, tobacco use, QoL, or psychological health. Participants in the iHeLP-alone condition (n=4) reported a mean reduction of 5.5 (SD 9.00) tobacco cigarettes per day between baseline and follow-up, with a concomitant mean reduction in expired carbon monoxide (CO) of 5.5 parts per million (ppm, SD 6.91). The iHeLP plus telephone support group (n=6) reported a mean reduction of 1.13 (SD 4.88) tobacco cigarettes per day and a mean reduction of 9.337 ppm of expired CO (SD 5.65). A urinalysis indicated that abstinence from cannabis was achieved by 2 participants in the iHeLP-alone group and three participants in the iHeLP plus telephone support group. Between baseline and follow-up assessments, iHeLP-alone participants reported a mean reduction in days of use of cannabis in the prior month of 6.17 days (SD 13.30). The average reduction in the number of days of cannabis use for the iHeLP plus telephone support group was also 6.17 days (SD 13.59). Conclusions: Despite the small sample size, this study provides preliminary support for the use of internet-delivered, tobacco-focused interventions in tobacco smokers seeking treatment for cannabis use. ",
doi="10.2196/14344",
url="https://formative.jmir.org/2020/12/e14344",
url="http://www.ncbi.nlm.nih.gov/pubmed/33284121"
}


@Article{info:doi/10.2196/15602,
author="Van Asbroeck, Stephanie
and Matthys, Christophe",
title="Use of Different Food Image Recognition Platforms in Dietary Assessment: Comparison Study",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="7",
volume="4",
number="12",
pages="e15602",
keywords="image recognition",
keywords="dietary assessment",
keywords="automated food recognition",
keywords="accuracy",
abstract="Background: In the domain of dietary assessment, there has been an increasing amount of criticism of memory-based techniques such as food frequency questionnaires or 24 hour recalls. One alternative is logging pictures of consumed food followed by an automatic image recognition analysis that provides information on type and amount of food in the picture. However, it is currently unknown how well commercial image recognition platforms perform and whether they could indeed be used for dietary assessment. Objective: This is a comparative performance study of commercial image recognition platforms. Methods: A variety of foods and beverages were photographed in a range of standardized settings. All pictures (n=185) were uploaded to selected recognition platforms (n=7), and estimates were saved. Accuracy was determined along with totality of the estimate in the case of multiple component dishes. Results: Top 1 accuracies ranged from 63\% for the application programming interface (API) of the Calorie Mama app to 9\% for the Google Vision API. None of the platforms were capable of estimating the amount of food. These results demonstrate that certain platforms perform poorly while others perform decently. Conclusions: Important obstacles to the accurate estimation of food quantity need to be overcome before these commercial platforms can be used as a real alternative for traditional dietary assessment methods. ",
doi="10.2196/15602",
url="https://formative.jmir.org/2020/12/e15602",
url="http://www.ncbi.nlm.nih.gov/pubmed/33284118"
}


@Article{info:doi/10.2196/22755,
author="Balcombe, Luke
and De Leo, Diego",
title="Psychological Screening and Tracking of Athletes and Digital Mental Health Solutions in a Hybrid Model of Care: Mini Review",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="14",
volume="4",
number="12",
pages="e22755",
keywords="athletes",
keywords="screening",
keywords="tracking",
keywords="engagement",
keywords="well-being",
keywords="stress",
keywords="adjustment",
keywords="COVID-19",
keywords="hybrid model of care",
keywords="digital mental health",
keywords="machine learning",
keywords="artificial intelligence",
abstract="Background: There is a persistent need for mental ill-health prevention and intervention among at-risk and vulnerable subpopulations. Major disruptions to life, such as the COVID-19 pandemic, present an opportunity for a better understanding of the experience of stressors and vulnerability. Faster and better ways of psychological screening and tracking are more generally required in response to the increased demand upon mental health care services. The argument that mental and physical health should be considered together as part of a biopsychosocial approach is garnering acceptance in elite athlete literature. However, the sporting population are unique in that there is an existing stigma of mental health, an underrecognition of mental ill-health, and engagement difficulties that have hindered research, prevention, and intervention efforts. Objective: The aims of this paper are to summarize and evaluate the literature on athletes' increased vulnerability to mental ill-health and digital mental health solutions as a complement to prevention and intervention, and to show relationships between athlete mental health problems and resilience as well as digital mental health screening and tracking, and faster and better treatment algorithms. Methods: This mini review shapes literature in the fields of athlete mental health and digital mental health by summarizing and evaluating journal and review articles drawn from PubMed Central and the Directory of Open Access Journals. Results: Consensus statements and systematic reviews indicated that elite athletes have comparable rates of mental ill-health prevalence to the general population. However, peculiar subgroups require disentangling. Innovative expansion of data collection and analytics is required to respond to engagement issues and advance research and treatment programs in the process. Digital platforms, machine learning, deep learning, and artificial intelligence are useful for mental health screening and tracking in various subpopulations. It is necessary to determine appropriate conditions for algorithms for use in recommendations. Partnered with real-time automation and machine learning models, valid and reliable behavior sensing, digital mental health screening, and tracking tools have the potential to drive a consolidated, measurable, and balanced risk assessment and management strategy for the prevention and intervention of the sequelae of mental ill-health. Conclusions: Athletes are an at-risk subpopulation for mental health problems. However, a subgroup of high-level athletes displayed a resilience that helped them to positively adjust after a period of overwhelming stress. Further consideration of stress and adjustments in brief screening tools is recommended to validate this finding. There is an unrealized potential for broadening the scope of mental health, especially symptom and disorder interpretation. Digital platforms for psychological screening and tracking have been widely used among general populations, but there is yet to be an eminent athlete version. Sports in combination with mental health education should address the barriers to help-seeking by increasing awareness, from mental ill-health to positive functioning. A hybrid model of care is recommended, combining traditional face-to-face approaches along with innovative and evaluated digital technologies, that may be used in prevention and early intervention strategies. ",
doi="10.2196/22755",
url="http://formative.jmir.org/2020/12/e22755/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33271497"
}


@Article{info:doi/10.2196/17317,
author="Kaufman, R. Michelle
and Casella, Albert
and Wiginton, Mark John
and Xu, Wenjian
and DuBois, L. David
and Arrington-Sanders, Renata
and Simon, Jeannette
and Levine, Deb",
title="Mentoring Young African American Men and Transgender Women Who Have Sex With Men on Sexual Health: Formative Research for an HIV Mobile Health Intervention for Mentors",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="17",
volume="4",
number="12",
pages="e17317",
keywords="mentoring",
keywords="HIV",
keywords="mobile app",
keywords="mHealth",
keywords="men who have sex with men",
keywords="transgender",
keywords="African Americans",
abstract="Background: African American men who have sex with men (MSM) and transgender women bear a disproportionate burden of HIV. Young MSM account for 75\% of this burden for youth. When youths lack socially protective resources such as strong networks of adults, including parents, teachers, or community members, mentors may play a critical role in promoting health behaviors. This is especially true for youth at risk for HIV, such as African American youth with sexual and gender minority (SGM) identities. In the past decade, natural mentoring and mentoring programs have proliferated as a key prevention and intervention strategy to improve outcomes for young people at risk for poor academic, social, and health issues. Mentors appear to be able to facilitate health promotion among young SGM by modeling healthy behaviors; however, mentors' knowledge and resource needs regarding sexual health topics including HIV are understudied, as is the potential role of mobile technology in enhancing mentoring relationships and the ability of mentors to learn about sensitive issues faced by youth. Objective: The aim of this study is to explore how mentoring plays a role in the sexual health of African American SGM youth and understand how mentoring relationships can be strengthened through mobile technology to promote youth HIV prevention behaviors. Methods: In-depth interviews were conducted with African American SGM youth mentees (n=17) and mentors (n=20) to such youths in 3 Mid-Atlantic cities. Mentee interviews focused on discussions regarding sexual health and HIV and how a mentor could broach such topics. Mentor interviews explored whether sexual health and HIV are currently mentoring topics, mentors' knowledge and confidence in mentoring on these issues, and barriers to discussions. All participants were asked if a mobile app could help facilitate mentoring on sensitive health issues, particularly HIV and sexual health. Data were transcribed, coded, and analyzed for relevant themes. Results: Sexual health was a common topic in mentoring relationships, occurring more in natural mentorships than in mentoring program pairs. Mentors and mentees felt positive about such discussions. Mentors expressed having limited knowledge beyond condom use and HIV testing, and expressed a need for more complete resources. Both mentors and mentees had mixed comfort levels when discussing sexual health. Sufficient trust and shared lived experiences made discussions easier. Mentees have multifaceted needs; however, mentors stated that an app resource that provided self-training, resources, support from other mentors, and tips for better mentoring could prove beneficial. Conclusions: For the African American SGM community, access to natural mentors is crucial for young people to learn healthy behaviors. A mobile resource to assist mentors in confidently having discussions with mentees may be a promising way to promote healthy practices. ",
doi="10.2196/17317",
url="https://formative.jmir.org/2020/12/e17317",
url="http://www.ncbi.nlm.nih.gov/pubmed/33331822"
}


@Article{info:doi/10.2196/17542,
author="Bashi, Nazli
and Varnfield, Marlien
and Karunanithi, Mohanraj",
title="A Smartphone App for Patients With Acute Coronary Syndrome (MoTER-ACS): User-Centered Design Approach",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="18",
volume="4",
number="12",
pages="e17542",
keywords="mobile health",
keywords="mHealth",
keywords="mobile health apps",
keywords="smartphone",
keywords="mobile phone",
keywords="self-management",
keywords="patient education",
keywords="cardiovascular disease",
keywords="acute coronary syndrome",
abstract="Background: Postdischarge interventions are limited for patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and the need to travel from remote areas. Smartphones have become viable lifestyle technology to deliver home-based educational and health interventions. Objective: The aim of this study was to develop a smartphone-based intervention for providing postdischarge support to patients with ACS. Methods: The content of Mobile Technology--Enabled Rehabilitation for Patients with ACS (MoTER-ACS) was derived from a series of small studies, termed prestudy surveys, conducted in 2017. The prestudy surveys were conducted in Prince Charles Hospital, Queensland, Australia, and consisted of questionnaires among a convenience sample of patients with ACS (n=30), a focus group discussion with health care professionals (n=10), and an online survey among cardiologists (n=15). Responses from the patient survey identified educational topics of MoTER-ACS. The focus group with health care professionals assisted with identifying educational materials, health monitoring, and self-management interventions. Based on the results of the cardiologists' survey, monitoring of symptoms related to heart failure exacerbation was considered as a weekly diary. Results: The MoTER-ACS app covers multimedia educational materials to adopt a healthy lifestyle and includes user-friendly tools to monitor physiological and health parameters such as blood pressure, weight, and pain, assisting patients in self-managing their condition. A web portal that is linked to the data from the smartphone app is available to clinicians to regularly access patients' data and provide support. Conclusions: The MoTER-ACS platform extends the capabilities of previous mobile health platforms by providing a home-based educational and self-management intervention for patients with ACS following discharge from the hospital. The MoTER-ACS intervention narrows the gap between existing hospital-based programs and home-based interventions by complementing the postdischarge program for patients with ACS. ",
doi="10.2196/17542",
url="http://formative.jmir.org/2020/12/e17542/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33337339"
}


@Article{info:doi/10.2196/17265,
author="Shao, Rulin
and He, Hongyu
and Chen, Ziwei
and Liu, Hui
and Liu, Dianbo",
title="Stochastic Channel-Based Federated Learning With Neural Network Pruning for Medical Data Privacy Preservation: Model Development and Experimental Validation",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="22",
volume="4",
number="12",
pages="e17265",
keywords="federated learning",
keywords="differential privacy preserving",
keywords="neural network pruning",
keywords="health care",
keywords="privacy",
keywords="medical data",
keywords="machine learning",
keywords="neural network",
abstract="Background: Artificial neural networks have achieved unprecedented success in the medical domain. This success depends on the availability of massive and representative datasets. However, data collection is often prevented by privacy concerns, and people want to take control over their sensitive information during both the training and using processes. Objective: To address security and privacy issues, we propose a privacy-preserving method for the analysis of distributed medical data. The proposed method, termed stochastic channel-based federated learning (SCBFL), enables participants to train a high-performance model cooperatively and in a distributed manner without sharing their inputs. Methods: We designed, implemented, and evaluated a channel-based update algorithm for a central server in a distributed system. The update algorithm will select the channels with regard to the most active features in a training loop, and then upload them as learned information from local datasets. A pruning process, which serves as a model accelerator, was further applied to the algorithm based on the validation set. Results: We constructed a distributed system consisting of 5 clients and 1 server. Our trials showed that the SCBFL method can achieve an area under the receiver operating characteristic curve (AUC-ROC) of 0.9776 and an area under the precision-recall curve (AUC-PR) of 0.9695 with only 10\% of channels shared with the server. Compared with the federated averaging algorithm, the proposed SCBFL method achieved a 0.05388 higher AUC-ROC and 0.09695 higher AUC-PR. In addition, our experiment showed that 57\% of the time is saved by the pruning process with only a reduction of 0.0047 in AUC-ROC performance and a reduction of 0.0068 in AUC-PR performance. Conclusions: In this experiment, our model demonstrated better performance and a higher saturating speed than the federated averaging method, which reveals all of the parameters of local models to the server. The saturation rate of performance could be promoted by introducing a pruning process and further improvement could be achieved by tuning the pruning rate. ",
doi="10.2196/17265",
url="http://formative.jmir.org/2020/12/e17265/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33350391"
}


@Article{info:doi/10.2196/22411,
author="Bennett, S. Alex
and Freeman, Robert
and Des Jarlais, C. Don
and Aronson, David Ian",
title="Reasons People Who Use Opioids Do Not Accept or Carry No-Cost Naloxone: Qualitative Interview Study",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="23",
volume="4",
number="12",
pages="e22411",
keywords="overdose",
keywords="opioids",
keywords="naloxone",
keywords="people who use opioids",
keywords="messaging",
keywords="harm reduction",
keywords="public health intervention",
abstract="Background: Many people use opioids and are at risk of overdose. Naloxone is an opioid antagonist used to counter the effects of opioid overdose. There is an increased availability of naloxone in New York City; however, many who use opioids decline no-cost naloxone even when offered. Others may have the medication but opt not to carry it and report that they would be reluctant to administer it if they were to witness an overdose. Objective: We aim to better understand why people who use opioids may be reluctant to accept, carry, and administer naloxone, and to inform the development of messaging content that addresses barriers to its acceptance and use. Methods: We conducted formative qualitative interviews with 20 people who use opioids who are 18 years and older in New York City. Participants were recruited via key informants and chain referral. Results: Participants cited 4 main barriers that may impede rates of naloxone acceptance, possession, and use: (1) stigma related to substance use, (2) indifference toward overdose, (3) fear of negative consequences of carrying naloxone, and (4) fear of misrecognizing the need for naloxone. Participants also offered suggestions about messaging content to tackle the identified barriers, including messages designed to normalize naloxone possession and use, encourage shared responsibility for community health, and elicit empathy for people who use drugs. Taken together, participants' narratives hold implications for the following potential messaging content: (1) naloxone is short-acting, and withdrawal sickness does not have to be long-lasting; (2) it is critical to accurately identify an opioid-involved overdose; (3) anyone can overdose; (4) naloxone cannot do harm; and (5) the prompt administration of the medication can help ensure that someone can enjoy another day. Finally, participants suggested that messaging should also debunk myths and stereotypes about people who use drugs more generally; people who use opioids who reverse overdoses should be framed as lay public health advocates and not just ``others'' to be managed with stigmatizing practices and language. Conclusions: It must be made a public health priority to get naloxone to people who use opioids who are best positioned to reverse an overdose, and to increase the likelihood that they will carry naloxone and use it when needed. Developing, tailoring, and deploying messages to address stigma, indifference toward overdose, fear and trepidation about reversing an overdose, and fear of police involvement may help alleviate fears among some people who are reluctant to obtain naloxone and use the medication on someone in an overdose situation. ",
doi="10.2196/22411",
url="http://formative.jmir.org/2020/12/e22411/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33355094"
}


@Article{info:doi/10.2196/21602,
author="Locher, Ione
and Waselewski, Marika
and Sonneville, Kendrin
and Resnicow, Ken
and Chang, Tammy",
title="Grocery Delivery of Healthy Foods to Pregnant Young Women With Low Incomes: Feasibility and Acceptability Mixed Methods Study",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="24",
volume="4",
number="12",
pages="e21602",
keywords="pregnancy",
keywords="adolescent",
keywords="young adult",
keywords="female",
keywords="gestational weight gain",
keywords="diet",
keywords="food preferences",
keywords="text messaging",
keywords="feasibility studies",
abstract="Background: Poor maternal diets increase the risk of excess gestational weight gain which can contribute to serious intergenerational morbidity for both the mother and infant. Pregnant young women with low incomes have disproportionately high rates of inadequate fruit and vegetable consumption as well as excess weight gains during pregnancy. Objective: Our aim was to describe the feasibility and acceptability of Special Delivery, a longitudinal nutrition intervention that delivers healthy foods to pregnant youth (aged 14-24 years) with low incomes. Methods: The Special Delivery pilot study, conducted in Michigan, enrolled pregnant young women with low incomes. Study participants were sent twice-monthly grocery deliveries consisting of US \$35 worth of healthy foods, primarily fruits and vegetables. Between grocery deliveries, participants received daily SMS text message prompts to confirm receipt of delivery and document diet and weight. Program feasibility was assessed by the number of grocery orders placed, delivered, and confirmed by participants. Qualitative interviews and SMS text message data were used to determine acceptability by assessing participants' perspectives on grocery delivery, participants' perspectives on dietary impact of the program, and foods consumed by participants. Results: A total of 27 participants were enrolled in the pilot study. The mean age was 20.3 years (SD 2.0), and 59.3\% (16/27) were African American or Black. During the pilot, 263 deliveries were sent with 98.5\% (259/263) successful deliveries and 89.4\% (235/263) deliveries confirmed by participants. Participants reported that grocery delivery was convenient; that delivered foods were high quality; and that the program improved their diet, increased access to healthy foods, and promoted healthy habits during pregnancy. Conclusions: A grocery delivery--based weight gain and nutrition intervention is both feasible and acceptable among low-income pregnant youth. Grocery deliveries were successfully completed and participants were willing and able to receive grocery deliveries, eat the healthy foods that were delivered, and communicate via SMS text message with study coordinators. The Special Delivery program warrants further evaluation for efficacy in promoting healthy weight gain for low-income youth during pregnancy. ",
doi="10.2196/21602",
url="http://formative.jmir.org/2020/12/e21602/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33361055"
}


@Article{info:doi/10.2196/24490,
author="Sai Prashanthi, Gumpili
and Deva, Ayush
and Vadapalli, Ranganath
and Das, Vipin Anthony",
title="Automated Categorization of Systemic Disease and Duration From Electronic Medical Record System Data Using Finite-State Machine Modeling: Prospective Validation Study",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="17",
volume="4",
number="12",
pages="e24490",
keywords="electronic health records",
keywords="data analysis",
keywords="machine learning",
keywords="algorithms",
keywords="ophthalmology",
abstract="Background: One of the major challenges in the health care sector is that approximately 80\% of generated data remains unstructured and unused. Since it is difficult to handle unstructured data from electronic medical record systems, it tends to be neglected for analyses in most hospitals and medical centers. Therefore, there is a need to analyze unstructured big data in health care systems so that we can optimally utilize and unearth all unexploited information from it. Objective: In this study, we aimed to extract a list of diseases and associated keywords along with the corresponding time durations from an indigenously developed electronic medical record system and describe the possibility of analytics from the acquired datasets. Methods: We propose a novel, finite-state machine to sequentially detect and cluster disease names from patients' medical history. We defined 3 states in the finite-state machine and transition matrix, which depend on the identified keyword. In addition, we also defined a state-change action matrix, which is essentially an action associated with each transition. The dataset used in this study was obtained from an indigenously developed electronic medical record system called eyeSmart that was implemented across a large, multitier ophthalmology network in India. The dataset included patients' past medical history and contained records of 10,000 distinct patients. Results: We extracted disease names and associated keywords by using the finite-state machine with an accuracy of 95\%, sensitivity of 94.9\%, and positive predictive value of 100\%. For the extraction of the duration of disease, the machine's accuracy was 93\%, sensitivity was 92.9\%, and the positive predictive value was 100\%. Conclusions: We demonstrated that the finite-state machine we developed in this study can be used to accurately identify disease names, associated keywords, and time durations from a large cohort of patient records obtained using an electronic medical record system. ",
doi="10.2196/24490",
url="http://formative.jmir.org/2020/12/e24490/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33331823"
}


@Article{info:doi/10.2196/23379,
author="Do, Quan
and Marc, David
and Plotkin, Marat
and Pickering, Brian
and Herasevich, Vitaly",
title="Starter Kit for Geotagging and Geovisualization in Health Care: Resource Paper",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="24",
volume="4",
number="12",
pages="e23379",
keywords="geographic mapping",
keywords="medicalGIS guidelines",
keywords="information storage and retrieval",
keywords="mapping",
keywords="geotagging",
keywords="data visualization",
keywords="population",
keywords="public health",
abstract="Background: Geotagging is the process of attaching geospatial tags to various media data types. In health care, the goal of geotagging is to gain a better understanding of health-related questions applied to populations. Although there has been a prevalence of geographic information in public health, in order to effectively use and expand geotagging across health care there is a requirement to understand other factors such as the disposition, standardization, data sources, technologies, and limitations. Objective: The objective of this document is to serve as a resource for new researchers in the field. This report aims to be comprehensive but easy for beginners to understand and adopt in practice. The optimal geocodes, their sources, and a rationale for use are suggested. Geotagging's issues and limitations are also discussed. Methods: A comprehensive review of technical instructions and articles was conducted to evaluate guidelines for geotagging, and online resources were curated to support the implementation of geotagging practices. Summary tables were developed to describe the available geotagging resources (free and for fee) that can be leveraged by researchers and quality improvement personnel to effectively perform geospatial analyses primarily targeting US health care. Results: This paper demonstrated steps to develop an initial geotagging and geovisualization project with clear structure and instructions. The geotagging resources were summarized. These resources are essential for geotagging health care projects. The discussion section provides better understanding of geotagging's limitations and suggests suitable way to approach it. Conclusions: We explain how geotagging can be leveraged in health care and offer the necessary initial resources to obtain geocodes, adjustment data, and health-related measures. The resources outlined in this paper can support an individual and/or organization in initiating a geotagging health care project. ",
doi="10.2196/23379",
url="http://formative.jmir.org/2020/12/e23379/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33361054"
}


@Article{info:doi/10.2196/19677,
author="Seely, W. Ellen
and Weitzman, Flynn Patricia
and Cortes, Dharma
and Romero Vicente, Sara
and Levkoff, E. Sue",
title="Development and Feasibility of an App to Decrease Risk Factors for Type 2 Diabetes in Hispanic Women With Recent Gestational Diabetes (Hola Beb{\'e}, Adi{\'o}s Diabetes): Pilot Pre-Post Study",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="31",
volume="4",
number="12",
pages="e19677",
keywords="gestational diabetes mellitus",
keywords="diabetes prevention",
keywords="Hispanic",
keywords="Latina",
keywords="intervention",
keywords="mobile apps",
keywords="mHealth",
abstract="Background: Hispanic women have increased risk of gestational diabetes mellitus (GDM), which carries an increased risk for future type 2 diabetes, compared to non-Hispanic women. In addition, Hispanic women are less likely to engage in healthy eating and physical activity, which are both risk factors for type 2 diabetes. Supporting patients to engage in healthy lifestyle behaviors through mobile health (mHealth) interventions is increasingly recognized as a viable, underused tool for disease prevention, as they reduce barriers to access frequently experienced in face-to-face interventions. Despite the high percentage of smartphone ownership among Hispanics, mHealth programs to reduce risk factors for type 2 diabetes in Hispanic women with prior GDM are lacking. Objective: This study aimed to (1) develop a mobile app ({\textexclamdown}Hola Beb{\'e}, Adi{\'o}s Diabetes!) to pilot test a culturally tailored, bilingual (Spanish/English) lifestyle program to reduce risk factors for type 2 diabetes in Hispanic women with GDM in the prior 5 years; (2) examine the acceptability and usability of the app; and (3) assess the short-term effectiveness of the app in increasing self-efficacy for both healthy eating and physical activity, and in decreasing weight. Methods: Social cognitive theory provided the framework for the study. A prototype app was developed based on prior research and cultural tailoring of content. Features included educational audiovisual modules on healthy eating and physical activity; personal action plans; motivational text messages; weight tracking; user-friendly, easy-to-follow recipes; directions on building a balanced plate; and tiered badges to reward achievements. Perceptions of the app's acceptability and usability were explored through four focus groups. Short-term effectiveness of the app was tested in an 8-week single group pilot study. Results: In total, 11 Hispanic women, receiving care at a federally qualified community health center, aged 18-45 years, and with GDM in the last 5 years, participated in four focus groups to evaluate the app's acceptability and usability. Participants found the following sections most useful: audiovisual modules, badges for completion of activities, weight-tracking graphics, and recipes. Suggested modifications included adjustments in phrasing, graphics, and a tiering system of badges. After app modifications, we conducted usability testing with 4 Hispanic women, with the key result being the suggestion for a ``how-to tutorial.'' To assess short-term effectiveness, 21 Hispanic women with prior GDM participated in the pilot. There was a statistically significant improvement in both self-efficacy for physical activity (P=.003) and self-efficacy for healthy eating (P=.007). Weight decreased but not significantly. Backend process data revealed a high level of user engagement. Conclusions: These data support the app's acceptability, usability, and short-term effectiveness, suggesting that this mHealth program has the potential to fill the gap in care experienced by Hispanic women with prior GDM following pregnancy. Future studies are needed to determine the effectiveness of an enhanced app in a randomized controlled trial. Trial Registration: ClinicalTrials.gov NCT04149054; https://clinicaltrials.gov/ct2/show/NCT04149054 ",
doi="10.2196/19677",
url="http://formative.jmir.org/2020/12/e19677/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33382039"
}


@Article{info:doi/10.2196/20871,
author="Selby, Kevin
and Durand, Marie-Anne
and Gouveia, Alexandre
and Bosisio, Francesca
and Barazzetti, Gaia
and Hostettler, Maxime
and D'Acremont, Val{\'e}rie
and Kaufmann, Alain
and von Plessen, Christian",
title="Citizen Responses to Government Restrictions in Switzerland During the COVID-19 Pandemic: Cross-Sectional Survey",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="3",
volume="4",
number="12",
pages="e20871",
keywords="COVID-19",
keywords="coronavirus",
keywords="Switzerland",
keywords="mitigation strategies",
keywords="citizen knowledge",
abstract="Background: The success of government-recommended mitigation measures during the COVID-19 pandemic depends largely on information uptake and implementation by individual citizens. Objective: Our aim was to assess citizens' knowledge and perceptions about COVID-19 recommendations in the Canton of Vaud, Switzerland. Methods: A cross-sectional electronic survey with open and closed questions was disseminated by community-based partners prior to the relaxation of government restrictions. Outcomes included citizen knowledge (9-question measure) and worry about the virus, perception of government measures, and recommendations for improvements. Comparisons used linear regression, controlling for age, sex, education, and health literacy. Free-text answers were analyzed thematically. Results: Of 807 people who accessed the survey, 684 (85\%) completed all questions and 479 (60\%) gave free-text recommendations. Overall, 75\% were female, the mean age was 48 years, and 93\% had high health literacy. Knowledge scores were high, with a median score of 8 out of 9. Mean levels of worry about the COVID-19 pandemic were higher in women than men (55/100 versus 44/100, P<.001), and in respondents with lower health literacy (57/100 versus 52/100, P=.03). Self-reported adherence to recommendations was high (85\%) and increased with age and worry (both P<.001). Respondents rated their own adherence higher than others (85\% versus 61\%, P<.001). Moreover, 34\% of respondents reported having self-quarantined; this rose to 52\% for those aged ?75 years. Those who had self-quarantined reported higher levels of fear. Nearly half (49\%) of respondents felt the government response had been adequate, though younger age and higher levels of worry were associated with considering the response to be insufficient (both P<.001). Analysis of open-text answers revealed 4 major themes: access to and use of masks, gloves, and hand sanitizer; government messaging; lockdown and lockdown exit plan communication; and testing for COVID-19. Conclusions: Knowledge, adherence, and satisfaction regarding government recommendations and response were high in this sample, but many desired greater access to personal protective equipment. Those with lower health literacy and those who have been in self-isolation reported greater concerns about the pandemic. ",
doi="10.2196/20871",
url="https://formative.jmir.org/2020/12/e20871",
url="http://www.ncbi.nlm.nih.gov/pubmed/33156809"
}


@Article{info:doi/10.2196/19270,
author="Patel, Devika
and Berger, Allen Christopher
and Kityamuwesi, Alex
and Ggita, Joseph
and Kunihira Tinka, Lynn
and Turimumahoro, Patricia
and Feler, Joshua
and Chehab, Lara
and Chen, Z. Amy
and Gupta, Nakull
and Turyahabwe, Stavia
and Katamba, Achilles
and Cattamanchi, Adithya
and Sammann, Amanda",
title="Iterative Adaptation of a Tuberculosis Digital Medication Adherence Technology to Meet User Needs: Qualitative Study of Patients and Health Care Providers Using Human-Centered Design Methods",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="8",
volume="4",
number="12",
pages="e19270",
keywords="human-centered design",
keywords="tuberculosis",
keywords="digital adherence technology",
keywords="digital health",
keywords="adherence",
keywords="medication",
keywords="treatment",
keywords="outcome",
keywords="lung",
keywords="respiratory",
keywords="infectious disease",
abstract="Background: Digital adherence technologies have been widely promoted as a means to improve tuberculosis medication adherence. However, uptake of these technologies has been suboptimal by both patients and health workers. Not surprisingly, studies have not demonstrated significant improvement in treatment outcomes. Objective: This study aimed to optimize a well-known digital adherence technology, 99DOTS, for end user needs in Uganda. We describe the findings of the ideation phase of the human-centered design methodology to adapt 99DOTS according to a set of design principles identified in the previous inspiration phase. Methods: 99DOTS is a low-cost digital adherence technology wherein tuberculosis medication blister packs are encased within an envelope that reveals toll-free numbers that patients can call to report dosing. We identified 2 key areas for design and testing: (1) the envelope, including the form factor, content, and depiction of the order of pill taking; and (2) the patient call-in experience. We conducted 5 brainstorming sessions with all relevant stakeholders to generate a suite of potential prototype concepts. Senior investigators identified concepts to further develop based on feasibility and consistency with the predetermined design principles. Prototypes were revised with feedback from the entire team. The envelope and call-in experience prototypes were tested and iteratively revised through focus groups with health workers (n=52) and interviews with patients (n=7). We collected and analyzed qualitative feedback to inform each subsequent iteration. Results: The 5 brainstorming sessions produced 127 unique ideas that we clustered into 6 themes: rewards, customization, education, logistics, wording and imagery, and treatment countdown. We developed 16 envelope prototypes, 12 icons, and 28 audio messages for prototype testing. In the final design, we altered the pill packaging envelope by adding a front flap to conceal the pills and reduce potential stigma associated with tuberculosis. The flap was adorned with either a blank calendar or map of Uganda. The inside cover contained a personalized message from a local health worker including contact information, pictorial pill-taking instructions, and a choice of stickers to tailor education to the patient and phase of treatment. Pill-taking order was indicated with colors, chevron arrows, and small mobile phone icons. Last, the call-in experience when patients report dosing was changed to a rotating series of audio messages centered on the themes of prevention, encouragement, and reassurance that tuberculosis is curable. Conclusions: We demonstrated the use of human-centered design as a promising tool to drive the adaptation of digital adherence technologies to better address the needs and motivations of end users. The next phase of research, known as the implementation phase in the human-centered design methodology, will investigate whether the adapted 99DOTS platform results in higher levels of engagement from patients and health workers, and ultimately improves tuberculosis treatment outcomes. ",
doi="10.2196/19270",
url="https://formative.jmir.org/2020/12/e19270",
url="http://www.ncbi.nlm.nih.gov/pubmed/33289494"
}


@Article{info:doi/10.2196/24430,
author="Adamou, Marios
and Fullen, Tim
and Galab, Nazmeen
and Mackintosh, Isobel
and Abbott, Karl
and Lowe, Deborah
and Smith, Claire",
title="Psychological Effects of the COVID-19 Imposed Lockdown on Adults with Attention Deficit/Hyperactivity Disorder: Cross-Sectional Survey Study",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="15",
volume="4",
number="12",
pages="e24430",
keywords="adult ADHD",
keywords="pandemic",
keywords="lockdown",
keywords="COVID-19",
keywords="well-being",
keywords="psychological",
keywords="intervention",
keywords="ADHD",
abstract="Background: The psychological effects of the COVID-19 government-imposed lockdown have been studied in several populations. These effects however have not been studied in adult populations with attention deficit/hyperactivity disorder (ADHD). Objective: We wanted to investigate the psychological effects of the COVID-19 imposed lockdown on an adult population with ADHD. Methods: We conducted a cross-sectional survey by administering the Patient Health Questionnaire-9, Generalized Anxiety Disorder Scale-7, Brief Adjustment Scale-6, Perceived Stress Scale, and Multidimensional Scale of Perceived Social Support to a pragmatic sample of adults with ADHD. Results: In total, 24 individuals (male: n=18, 75\%; female: n=6, 25\%; age: mean 21.75 years, SD 1.85 years) were included in this study. The adults with ADHD we surveyed had significant levels of emotional distress during the COVID-19 pandemic period. However, there was no evidence of significant deterioration to the mental health of our sample during the COVID-19 pandemic. Conclusions: When treatment for ADHD is maintained, the effects of the COVID-19 pandemic on the mental health of adults with ADHD are mild. Targeted psychological interventions may be useful in such circumstances. ",
doi="10.2196/24430",
url="https://formative.jmir.org/2020/12/e24430",
url="http://www.ncbi.nlm.nih.gov/pubmed/33108312"
}


@Article{info:doi/10.2196/24776,
author="Ngoc Cong Duong, Khanh
and Nguyen Le Bao, Tien
and Thi Lan Nguyen, Phuong
and Vo Van, Thanh
and Phung Lam, Toi
and Pham Gia, Anh
and Anuratpanich, Luerat
and Vo Van, Bay",
title="Psychological Impacts of COVID-19 During the First Nationwide Lockdown in Vietnam: Web-Based, Cross-Sectional Survey Study",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="15",
volume="4",
number="12",
pages="e24776",
keywords="COVID-19",
keywords="mental health",
keywords="psychological distress",
keywords="depression",
keywords="anxiety",
keywords="Vietnam",
keywords="psychology",
keywords="distress",
keywords="lockdown",
keywords="survey",
abstract="Background: The first nationwide lockdown due to the COVID-19 pandemic was implemented in Vietnam from April 1 to 15, 2020. Nevertheless, there has been limited information on the impact of COVID-19 on the psychological health of the public. Objective: This study aimed to estimate the prevalence of psychological issues and identify the factors associated with the psychological impact of COVID-19 during the first nationwide lockdown among the general population in Vietnam. Methods: We employed a cross-sectional study design with convenience sampling. A self-administered, online survey was used to collect data and assess psychological distress, depression, anxiety, and stress of participants from April 10 to 15, 2020. The Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety, and Stress Scale-21 (DASS-21) were utilized to assess psychological distress, depression, anxiety, and stress of participants during social distancing due to COVID-19. Associations across factors were explored using regression analysis. Results: A total of 1385 respondents completed the survey. Of this, 35.9\% (n=497) experienced psychological distress, as well as depression (n=325, 23.5\%), anxiety (n=195, 14.1\%), and stress (n=309, 22.3\%). Respondents who evaluated their physical health as average had a higher IES-R score (beta coefficient [B]=9.16, 95\% CI 6.43 to 11.89), as well as higher depression (B=5.85, 95\% CI 4.49 to 7.21), anxiety (B=3.64, 95\% CI 2.64 to 4.63), and stress (B=5.19, 95\% CI 3.83 to 6.56) scores for DASS-21 than those who rated their health as good or very good. Those who self-reported their health as bad or very bad experienced more severe depression (B=9.57, 95\% CI 4.54 to 14.59), anxiety (B=7.24, 95\% CI 3.55 to 10.9), and stress (B=10.60, 95\% CI 5.56 to 15.65). Unemployment was more likely to be associated with depression (B=3.34, 95\% CI 1.68 to 5.01) and stress (B=2.34, 95\% CI 0.84 to 3.85). Regarding worries about COVID-19, more than half (n=755, 54.5\%) expressed concern for their children aged <18 years, which increased their IES-R score (B=7.81, 95\% CI 4.98 to 10.64) and DASS-21 stress score (B=1.75, 95\% CI 0.27 to 3.24). The majority of respondents (n=1335, 96.4\%) were confident about their doctor's expertise in terms of COVID-19 diagnosis and treatment, which was positively associated with less distress caused by the outbreak (B=--7.84, 95\% CI --14.58 to --1.11). Conclusions: The findings highlight the effect of COVID-19 on mental health during the nationwide lockdown among the general population in Vietnam. The study provides useful evidence for policy decision makers to develop and implement interventions to mitigate these impacts. ",
doi="10.2196/24776",
url="http://formative.jmir.org/2020/12/e24776/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33284778"
}


@Article{info:doi/10.2196/25469,
author="Severe, Jennifer
and Tang, Ruiqi
and Horbatch, Faith
and Onishchenko, Regina
and Naini, Vidisha
and Blazek, Carol Mary",
title="Factors Influencing Patients' Initial Decisions Regarding Telepsychiatry Participation During the COVID-19 Pandemic: Telephone-Based Survey",
journal="JMIR Form Res",
year="2020",
month="Dec",
day="22",
volume="4",
number="12",
pages="e25469",
keywords="telepsychiatry",
keywords="COVID-19",
keywords="video visit",
keywords="telephone visit",
keywords="telehealth",
keywords="mental health",
keywords="United States",
keywords="decision making",
keywords="virtual care",
abstract="Background: Telepsychiatry enables patients to establish or maintain psychiatric care during the COVID-19 pandemic. Little is known about the factors influencing patients' initial decisions to participate in telepsychiatry in the midst of a public health crisis. Objective: This paper seeks to examine factors influencing patients' initial decisions to accept or decline telepsychiatry immediately after the stay-at-home order in Michigan, their initial choice of virtual care modality (video or telephone), and their anticipated participation in telepsychiatry once clinics reopen for in-person visits. Methods: Between June and August 2020, we conducted a telephone-based survey using a questionnaire comprising 14 quantitative and two qualitative items as part of a quality improvement initiative. We targeted patients who had an in-person appointment date that fell in the first few weeks following the Michigan governor's stay-at-home order, necessitating conversion to virtual visits or deferment of in-person care. We used descriptive statistics to report individual survey responses and assess the association between chosen visit type and patient characteristics and future participation in telepsychiatry using multivariable logistic regression. Results: A total of 244 patients whose original in-person appointments were scheduled within the first 3 weeks of the stay-at-home order in Michigan completed the telephone survey. The majority of the 244 respondents (n=202, 82.8\%) initially chose to receive psychiatric care through video visits, while 13.5\% (n=33) chose telephone visits and 1.2\% (n=3) decided to postpone care until in-person visit availability. Patient age correlated with chosen visit type (P<.001; 95\% CI 0.02-0.06). Patients aged ?44 years were more likely than patients aged 0-44 years to opt for telephone visits (relative risk reduction [RRR] 1.2; 95\% CI 1.06-1.35). Patient sex (P=.99), race (P=.06), type of insurance (P=.08), and number of previous visits to the clinic (P=.63) were not statistically relevant. Half of the respondents (132/244, 54.1\%) stated theywere likely to continue with telepsychiatry even after in-person visits were made available. Telephone visit users were less likely than video visit users to anticipate future participation in telepsychiatry (RRR 1.08; 95\% CI 0.97-1.2). Overall, virtual visits met or exceeded expectations for the majority of users. Conclusions: In this cohort, patient age correlates with the choice of virtual visit type, with older adults more likely to choose telephone visits over video visits. Understanding challenges to patient-facing technologies can help advance health equity and guide best practices for engaging patients and families through telehealth. ",
doi="10.2196/25469",
url="https://formative.jmir.org/2020/12/e25469",
url="http://www.ncbi.nlm.nih.gov/pubmed/33320823"
}