@Article{info:doi/10.2196/16831,
author="Kristjansdottir, Birna Ol{\"o}f
and B{\o}r{\o}sund, Elin
and Westeng, Marianne
and Ruland, Cornelia
and Stenberg, Una
and Zangi, A. Heidi
and Stange, Kurt
and Mirkovic, Jelena",
title="Mobile App to Help People With Chronic Illness Reflect on Their Strengths: Formative Evaluation and Usability Testing",
journal="JMIR Form Res",
year="2020",
month="Mar",
day="4",
volume="4",
number="3",
pages="e16831",
keywords="mobile app",
keywords="self-management",
keywords="strengths",
keywords="chronic illness",
keywords="rheumatology",
keywords="usability",
keywords="formative evaluation",
abstract="Background: Supporting patient engagement and empowerment is increasingly seen as essential in providing person-centered health care to people with chronic illness. Mobile apps helping patients reflect on their concerns as preparation for consultations with their health care providers can have beneficial effects on the consultation quality. However, apps focusing on empowerment and personal strengths are still scarce. Objective: This study aimed to (1) develop a mobile app to support patients with rheumatic diseases in reflecting on their strengths in preparation for consultations with health care providers and (2) explore patients' perceived usability of the app in a nonclinical test setting. Methods: A prototype app was developed based on input from patients and health care providers, as reported in previous studies. The app was designed for use in self-management support settings aiming to promote awareness of strengths and to focus attention on strengths in the patient-health care provider dialogue. The features included in the prototype were as follows: (1) introduction to the topic of strengths, (2) list of examples of strengths to promote reflection and registration of own strengths, (3) summary of registered strengths, (4) value-based goal setting, (5) linking of strengths to goals, (6) summary of all registrations, and (7) options to share summary digitally or as a print version. In this study, the app was refined through a formative evaluation with patients and health care providers recruited from a specialized rheumatology hospital unit. Patients' perceptions of the app's usability were explored in a test setting with self-report measurements and semistructured interviews. The interviews were audiotaped, transcribed, and analyzed with directed content analysis. Data from questionnaires were analyzed with descriptive statistics. Results: Developmental and formative evaluation included 18 patients and 7 health care providers. The evaluation resulted in minor adjustments to the prototype but no major changes in features. The usability testing included 12 patients. All participants found the usability acceptable; the median score on the System Usability Scale was 86.3 (range 70-100). All reported that it was meaningful and relevant to use the app. Out of 12 participants, 9 (75\%) reported becoming more aware of their own strengths by using the app; 1 (8\%) disagreed and 2 (17\%) provided a neutral response. The results on the goal-related feature were mixed, with half of the patients finding it useful to link strengths to concrete goals. A statistically significant positive change from pre- to postintervention was identified on measures of self-efficacy and negative emotions. Conclusions: In this formative evaluation of a mobile app to promote patients' reflections on their strengths, patients perceived the app as meaningful and supporting awareness. The results suggest the usefulness of building in functionality to support use of strengths and goal attainment. Further studies on efficacy and usability in a clinical setting, including health care providers, are needed. ",
doi="10.2196/16831",
url="https://formative.jmir.org/2020/3/e16831",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130126"
}


@Article{info:doi/10.2196/17060,
author="Talboom-Kamp, Esther
and Tossaint-Schoenmakers, Rosian
and Goedhart, Annelijn
and Versluis, Anke
and Kasteleyn, Marise",
title="Patients' Attitudes Toward an Online Patient Portal for Communicating Laboratory Test Results: Real-World Study Using the eHealth Impact Questionnaire",
journal="JMIR Form Res",
year="2020",
month="Mar",
day="4",
volume="4",
number="3",
pages="e17060",
keywords="patient portals",
keywords="eHealth Impact Questionnaire",
keywords="eHIQ",
keywords="laboratory test results",
keywords="attitude to health",
keywords="self efficacy",
keywords="telemedicine",
keywords="usability",
abstract="Background: Communicating laboratory test results online has several advantages for patients, such as improving clinical efficiency and accessibility, thereby helping patients to take an active role in managing their health. Objective: This study aimed to investigate the experiences and self-efficacy of patients using an online patient portal that communicates laboratory test results. Methods: We used the online-administered eHealth Impact Questionnaire to explore patients' attitudes toward the portal. Patients visiting the portal were asked to complete the questionnaire. The subscale Information and Presentation assessed the usability of the patient portal and the subscale Motivation and Confidence to Act assessed self-efficacy to determine whether patients were motivated to act on the presented information. We used a cutoff score of 65 or greater to determine whether the portal was rated positively. Results: The questionnaire was completed by 354 of 13,907 patients who viewed their laboratory results in the patient portal, with a response rate of 2.55\%. The mean Information and Presentation score was 67.70 (SD 13.12) and the mean Motivation and Confidence to Act score was 63.59 (SD 16.22). We found a positive, significant correlation between the 2 subscales (r345=.77, P<.001). Conclusions: Patients participating in the study rated the usability of the portal positively. However, the portal only slightly helped patients to take an active role in managing their own health. The low response rate precludes generalization of the results. Future research should examine avenues to further increase patients' self-efficacy and study whether portal acceptability differs in subgroups. Patient portals conveying laboratory test results in understandable language seem usable and potentially provide a viable way to help patients take a more active role in managing their own health. ",
doi="10.2196/17060",
url="https://formative.jmir.org/2020/3/e17060",
url="http://www.ncbi.nlm.nih.gov/pubmed/32024632"
}


@Article{info:doi/10.2196/15962,
author="Park, Young Sun
and Andalibi, Nazanin
and Zou, Yikai
and Ambulkar, Siddhant
and Huh-Yoo, Jina",
title="Understanding Students' Mental Well-Being Challenges on a University Campus: Interview Study",
journal="JMIR Form Res",
year="2020",
month="Mar",
day="5",
volume="4",
number="3",
pages="e15962",
keywords="emerging adults",
keywords="university students",
keywords="life events",
keywords="mental wellbeing",
keywords="mental wellness",
keywords="mental health",
keywords="social support",
abstract="Background: Research shows that emerging adults face numerous stressors as they transition from adolescence to adulthood. This paper investigates university students' lived experiences of maintaining mental well-being during major life events and challenges associated with this transitional period. As we continue to design health technology to support students' mental health needs, it is imperative to understand the fundamental needs and issues particular to this phase of their life to effectively engage and lower the barriers to seeking help. Objective: This study first aimed to understand how university students currently seek and receive support to maintain their mental well-being while going through frequent life events during this period of emerging adulthood. The study then aimed to provide design requirements for how social and technical systems should support the students' mental well-being maintenance practice. Methods: Semistructured interviews with 19 students, including graduate and undergraduate students, were conducted at a large university in the Midwest in the United States. Results: This study's findings identified three key needs: students (1) need to receive help that aligns with the perceived severity of the problem caused by a life event, (2) have to continuously rebuild relationships with support givers because of frequent life events, and (3) negotiate tensions between the need to disclose and the stigma associated with disclosure. The study also identified three key factors related to maintaining mental well-being: time, audience, and disclosure. Conclusions: On the basis of this study's empirical findings, we discuss how and when help should be delivered through technology to better address university students' needs for maintaining their mental well-being, and we argue for reconceptualizing seeking and receiving help as a colearning process. ",
doi="10.2196/15962",
url="http://formative.jmir.org/2020/3/e15962/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32134393"
}


@Article{info:doi/10.2196/14652,
author="Sanchez Antelo, Victoria
and Kohler, E. Racquel
and Curotto, Mariana
and Viswanath, ``Vish'' Kasisomayajula
and Paolino, Melisa
and Arrossi, Silvina",
title="Developing SMS Content to Promote Papanicolaou Triage Among Women Who Performed HPV Self-collection Test: Qualitative Study",
journal="JMIR Form Res",
year="2020",
month="Mar",
day="6",
volume="4",
number="3",
pages="e14652",
keywords="text messaging",
keywords="cell phone use",
keywords="telemedicine",
keywords="human papillomavirus DNA tests",
keywords="triage",
keywords="health behavior",
keywords="Argentina",
abstract="Background: SMS interventions are effective in promoting a variety of health behaviors; however, there is limited information regarding the use of SMS for cervical cancer screening and follow-up care. The Application of Communication and Information Technologies to Self-Collection study aims to evaluate a multicomponent mobile health intervention to increase triage adherence among women with human papillomavirus (HPV)--positive self-collected tests in Jujuy, Argentina. Here, we describe the formative results used to design the content of the SMS to be tested in the trial. Objective: This study aimed to understand the cultural and contextual elements, women's beliefs, and perceptions regarding the use of SMS by the health care system and women's preferences about the message content. Methods: We conducted five focus groups (FGs), stratified by rural or urban residence and age. All participants were aged 30 years or older and had performed HPV self-collection. Participatory techniques, including brainstorming, card-based classification, and discussions were used to debate the advantages and disadvantages of messages. We openly coded the discussions for agreements and preferences regarding the SMS content. Messages for both HPV-negative and HPV-positive women were validated through interviews with health authorities and 14 HPV-tested women. The final versions of the messages were pilot-tested. Results: A total of 48 women participated in the FGs. Participants rejected receiving both negative and positive HPV results by SMS because, for them, the delivery of results should be done in a face-to-face interaction with health professionals. They stressed the importance of the SMS content informing them that results were available for pick up and reflecting the kind of relationship that they have with the community health workers and the nearest health center. Women considered that a personalized SMS was important, as was the use of a formal yet warm tone. Owing to confidentiality issues, not using the word ``HPV'' was also a key component of the desired SMS content; therefore, the final message included the term ``self-collection'' without the mention of HPV infection. Results from the validation stage and pilot test showed high acceptability of the final version of the message. Conclusions: The results suggest that SMS is accepted when notifying women about the availability of the HPV test result, but it should not replace the delivery of results in face-to-face, doctor-patient encounters. In addition, messages must be tailored and must have a persuasive tone to motivate women to adhere to the triage. ",
doi="10.2196/14652",
url="https://formative.jmir.org/2020/3/e14652",
url="http://www.ncbi.nlm.nih.gov/pubmed/32032940"
}


@Article{info:doi/10.2196/13900,
author="Nyenhuis, M. Sharmilee
and Balbim, Moraes Guilherme
and Ma, Jun
and Marquez, X. David
and Wilbur, JoEllen
and Sharp, K. Lisa
and Kitsiou, Spyros",
title="A Walking Intervention Supplemented With Mobile Health Technology in Low-Active Urban African American Women With Asthma: Proof-of-Concept Study",
journal="JMIR Form Res",
year="2020",
month="Mar",
day="11",
volume="4",
number="3",
pages="e13900",
keywords="activity trackers",
keywords="text message",
keywords="physical activity",
keywords="asthma",
keywords="African-American",
keywords="women",
keywords="mHealth",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Physical inactivity is associated with worse asthma outcomes. African American women experience disparities in both physical inactivity and asthma relative to their white counterparts. We conducted a modified evidence-based walking intervention supplemented with mobile health (mHealth) technologies to increase physical activity (PA). Objective: This study aimed to assess the preliminary feasibility of a 7-week walking intervention modified for African American women with asthma. Methods: African American women with suboptimally controlled asthma were identified from a health system serving low-income minorities. At a baseline data collection visit, participants performed spirometry and incremental shuttle walk test, completed questionnaires, and were given an accelerometer to wear for 1 week. The intervention comprised an informational study manual and 3 in-person group sessions over 7 weeks, led by a nurse interventionist, in a community setting. The supplemental mHealth tools included a wearable activity tracker device (Fitbit Charge HR) and one-way text messages related to PA and asthma 3 times per week. A secure Web-based research platform, iCardia, was used to obtain Fitbit data in real time (wear time, moderate-to-vigorous physical activity [MVPA] and sedentary time) and send text messages. The feasibility of the intervention was assessed in the domains of recruitment capability, acceptability (adherence, retention, engagement, text messaging, acceptability, complaints, and concerns), and preliminary outcome effects on PA behavior (change in steps, duration, and intensity). Results: We approached 22 women, of whom 10 were eligible; 7 consented, enrolled and completed the study. Group session attendance was 71\% (5/7), 86\% (6/7), and 86\% (6/7), respectively, across the 3 sessions. All participants completed evaluations at each group session. The women reported being satisfied or very satisfied with the program (eg, location, time, and materials). None of them had concerns about using, charging, or syncing the Fitbit device and app. Participants wore their Fitbit device for at least 10 hours per day in 44 out of the 49 intervention days. There was an increase in Fitbit-measured MVPA from week 1 (19 min/week, SD 14 min/week) to the last week of intervention (22 min/week, SD 12 min/week; Cohen d=0.24, 95\% CI 0.1 to 6.4). A slight decrease in step count was observed from week 1 (8926 steps/day, SD 2156 steps/day) to the last week of intervention (8517 steps/day, SD 1612 steps/day; Cohen d=?0.21, 95\% CI ?876.9 to 58.9). Conclusions: The initial feasibility results of a 7-week community-based walking intervention tailored for African American women with asthma and supplemented with mHealth tools are promising. Modifications to recruitment, retention, and the intervention itself are needed. These findings support the need to conduct a further modified pilot trial to collect additional data on feasibility and estimate the efficacy of the intervention on asthma and PA outcomes. ",
doi="10.2196/13900",
url="https://formative.jmir.org/2020/3/e13900",
url="http://www.ncbi.nlm.nih.gov/pubmed/32159520"
}


@Article{info:doi/10.2196/15494,
author="Chien, Shuo-Chen
and Islam, Mohaimenul Md
and Yeh, Chen-An
and Chien, Po-Han
and Chen, You Chun
and Chin, Yen-Po
and Lin, Ming-Chin",
title="Mutual-Aid Mobile App for Emergency Care: Feasibility Study",
journal="JMIR Form Res",
year="2020",
month="Mar",
day="19",
volume="4",
number="3",
pages="e15494",
keywords="technology acceptance model",
keywords="cardiopulmonary resuscitation",
keywords="mobile app",
keywords="emergency care",
abstract="Background: Improving the quality of patient care through the use of mobile devices is one of the hot topics in the health care field. In unwanted situations like an accident, ambulances and rescuers often require a certain amount of time to arrive at the scene. Providing immediate cardiopulmonary resuscitation (CPR) to patients might improve survival. Objective: The primary objective of this study was to evaluate the feasibility of an emergency and mutual-aid app model in Taiwan and to provide a reference for government policy. Methods: A structured questionnaire was developed as a research tool. All questionnaires were designed according to the technology acceptance model, and a Likert scale was used to measure the degree of agreement or disagreement. Moreover, in-depth interviews were conducted with six experts from medical, legal, and mobile app departments. Each expert was interviewed once to discuss feasible countermeasures and suggestions. Statistical Package for the Social Sciences (SPSS version 19; IBM Corp, Armonk, New York) was used to perform all statistical analyses, including descriptive statistics, independent sample t-tests, variance analysis, and Pearson correlation analysis. Results: We conducted this study between October 20, 2017, and November 10, 2017, at the Taipei Medical University Hospital. Questionnaires were distributed to medical personnel, visiting guests, family members, and volunteers. A total of 113 valid questionnaires were finally obtained after the exclusion of incomplete questionnaires. Cronbach $\alpha$ values for self-efficacy (perceived ease of use), use attitude (perceived usefulness), and use willingness and frequency were above .85, meeting the criterion of greater than .70. We observed that the reliability of each subquestion was acceptable and the values for use attitude (perceive usefulness) and use willingness and frequency were more than .90. Conclusions: The findings suggest that perceived ease of use and perceived usefulness of the app model affect use willingness. However, perceived usefulness had an intermediary influence on use willingness. Experts in law, medical, and technology fields consider that an emergency and mutual-aid model can be implemented in Taiwan. Along with the development of an emergency and mutual-aid app model, we recommend an increase in the number of automated external defibrillators per region and promotion of correct knowledge about CPR in order to decrease morbidity and mortality. ",
doi="10.2196/15494",
url="https://formative.jmir.org/2020/3/e15494",
url="http://www.ncbi.nlm.nih.gov/pubmed/32191212"
}