@Article{info:doi/10.2196/14504,
author="Allison, Rosalie
and Hayes, Catherine
and Young, Vicki
and McNulty, M. Cliodna A.",
title="Evaluation of an Educational Health Website on Infections and Antibiotics in England: Mixed Methods, User-Centered Approach",
journal="JMIR Form Res",
year="2020",
month="Apr",
day="6",
volume="4",
number="4",
pages="e14504",
keywords="user experience",
keywords="usability",
keywords="quality",
keywords="online",
keywords="science",
keywords="health",
abstract="Background: e-Bug, an educational health website for teachers and students, aims to help control antibiotic resistance by educating young people about microbes, hygiene, and antibiotic resistance, reducing the incidence of infection and, therefore, the need for antibiotics. The teachers' section of the e-Bug website has not been evaluated since it was launched in 2009, and worldwide page views have been steadily decreasing since 2013. Objective: This study aimed to apply GoodWeb, a comprehensive framework utilizing methodologies and attributes that are relevant to the digital era, to evaluate and suggest improvements to the e-Bug website. Methods: Electronic questionnaires and face-to-face completion of task scenarios were used to assess content, ease of use, interactivity, technical adequacy, appearance, effectiveness, efficiency, and learnability of the teachers' section of the e-Bug website. Results: A total of 106 teachers evaluated the e-Bug website; 97.1\% (103/106) of them reported that they would use e-Bug, and 98.1\% (104/106) of them reported that they would recommend it to others. Participants thought that there was a niche for e-Bug because of the way the resources fit into the national curriculum. Suggestions for improvements included changing the menu indication by highlighting the current page or deactivating links, improving home page indication, and providing a preview of resources when hovering the mouse over hyperlinks. Additional features requested by users included a search function and access to training opportunities. Conclusions: This paper reports that the GoodWeb framework was successfully applied to evaluate the e-Bug website, and therefore, it could be used to guide future website evaluations in other fields. Results from this study will be used to appraise the current quality and inform any future changes, modifications, and additions to e-Bug. ",
doi="10.2196/14504",
url="https://formative.jmir.org/2020/4/e14504",
url="http://www.ncbi.nlm.nih.gov/pubmed/32203932"
}


@Article{info:doi/10.2196/17901,
author="Gannon, Brittany
and Davis, Rindcy
and Kuhns, M. Lisa
and Rodriguez, Garibay Rafael
and Garofalo, Robert
and Schnall, Rebecca",
title="A Mobile Sexual Health App on Empowerment, Education, and Prevention for Young Adult Men (MyPEEPS Mobile): Acceptability and Usability Evaluation",
journal="JMIR Form Res",
year="2020",
month="Apr",
day="7",
volume="4",
number="4",
pages="e17901",
keywords="young adults",
keywords="usability",
keywords="HIV",
keywords="mHealth",
keywords="young men",
keywords="mobile phone",
abstract="Background: HIV incidence among young adult men who have sex with men (MSM), particularly among black and Latino men, continues to rise. As such, continued HIV prevention interventions for young MSM of color are of utmost importance. Male Youth Pursuing Empowerment, Education and Prevention around Sexuality (MyPEEPS) Mobile is a comprehensive HIV prevention and sexual health education smartphone app initially created to promote sexual health and HIV prevention among adolescent sexual minority young men aged 13 to 18 years. Objective: The objective of this study was to critically appraise the acceptability and usability of MyPEEPS Mobile for young adult MSM aged 19 to 25 years. Methods: Study participants used the mobile app, completed usability questionnaires and in-depth interviews, and reported their experience using the app. Analysis of interview data was guided by the Unified Theory of Acceptance and Use of Technology (UTAUT) to better understand the usability and acceptability of this intervention for young adults. Interview data were coded using the following constructs from the UTAUT model: performance expectancy, effort expectancy, and social influence. Results: A total of 20 young adult MSM (n=10 in Chicago, Illinois, and n=10 in New York, New York) were enrolled in the study. Participants reported that MyPEEPS Mobile was free of functional problems (Health Information Technology Usability Evaluation Scale scores and Post-Study System Usability Questionnaire scores consistent with high usability), easy to use, and useful, with an engaging approach that increased acceptability, including the use of avatars and animation, and inclusive representation of the diverse identities by race and ethnicity, gender identity, and sexual orientation. Recommended areas for improving MyPEEPS Mobile for the target demographic included more adult-oriented graphics, advanced educational content, scenarios for youth with more sexual experience, and search function to increase accessibility of key content. Conclusions: Overall, young adult MSM aged 19 to 25 years described the MyPEEPS Mobile as educational, informative, and usable for their sexual health education and HIV prevention needs, and they provided actionable recommendations to optimize its use and applicability for this age group. ",
doi="10.2196/17901",
url="https://formative.jmir.org/2020/4/e17901",
url="http://www.ncbi.nlm.nih.gov/pubmed/32254043"
}


@Article{info:doi/10.2196/15534,
author="Brown, Marie Jacqueline
and Savaglio, Robert
and Watson, Graham
and Kaplansky, Allison
and LeSage, Ann
and Hughes, Janette
and Kapralos, Bill
and Arcand, JoAnne",
title="Optimizing Child Nutrition Education With the Foodbot Factory Mobile Health App: Formative Evaluation and Analysis",
journal="JMIR Form Res",
year="2020",
month="Apr",
day="17",
volume="4",
number="4",
pages="e15534",
keywords="mHealth",
keywords="children",
keywords="child nutrition sciences",
keywords="mobile apps",
keywords="health education",
abstract="Background: Early nutrition interventions to improve food knowledge and skills are critical in enhancing the diet quality of children and reducing the lifelong risk of chronic disease. Despite the rise of mobile health (mHealth) apps and their known effectiveness for improving health behaviors, few evidence-based apps exist to help engage children in learning about nutrition and healthy eating. Objective: This study aimed to describe the iterative development and user testing of Foodbot Factory, a novel nutrition education gamified app for children to use at home or in the classroom and to present data from user testing experiments conducted to evaluate the app. Methods: An interdisciplinary team of experts in nutrition, education (pedagogy), and game design led to the creation of Foodbot Factory. First, a literature review and an environmental scan of the app marketplace were conducted, and stakeholders were consulted to define the key objectives and content of Foodbot Factory. Dietitian and teacher stakeholders identified priority age groups and learning objectives. Using a quasi-experimental mixed method design guided by the Iterative Convergent Design for Mobile Health Usability Testing approach, five app user testing sessions were conducted among students (ages 9-12 years). During gameplay, engagement and usability were assessed via direct observations with a semistructured form. After gameplay, qualitative interviews and questionnaires were used to assess user satisfaction, engagement, usability, and knowledge gained. Results: The environmental scan data revealed that few evidence-based nutrition education apps existed for children. A literature search identified key nutrients of concern for Canadian children and techniques that could be incorporated into the app to engage users in learning. Foodbot Factory included characters (2 scientists and Foodbots) who initiate fun and engaging dialogue and challenges (minigames), with storylines incorporating healthy eating messages that align with the established learning objectives. A total of five modules were developed: drinks, vegetables and fruit, grain foods, animal protein foods, and plant protein foods. Seven behavior change techniques and three unique gamified components were integrated into the app. Data from each user testing session were used to inform and optimize the next app iteration. The final user testing session demonstrated that participants agreed that they wanted to play Foodbot Factory again (12/17, 71\%), that the app is easy to use (12/17, 71\%) and fun (14/17, 88\%), and that the app goals were clearly presented (15/17, 94\%). Conclusions: Foodbot Factory is an engaging and educational mHealth intervention for the Canadian public that is grounded in evidence and developed by an interdisciplinary team of experts. The use of an iterative development approach is a demonstrated method to improve engagement, satisfaction, and usability with each iteration. Children find Foodbot Factory to be fun and easy to use, and can engage children in learning about nutrition. ",
doi="10.2196/15534",
url="http://formative.jmir.org/2020/4/e15534/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32301743"
}


@Article{info:doi/10.2196/12098,
author="Wong, Wai William Chi
and Song, Lin
and See, Christopher
and Lau, Hei Stephanie Tze
and Sun, Han Wai
and Choi, Ying Kitty Wai
and Tucker, Joseph",
title="Using Crowdsourcing to Develop a Peer-Led Intervention for Safer Dating App Use: Pilot Study",
journal="JMIR Form Res",
year="2020",
month="Apr",
day="21",
volume="4",
number="4",
pages="e12098",
keywords="dating apps",
keywords="intervention mapping",
keywords="crowdsourcing",
keywords="peer-led approach",
keywords="sexual health",
abstract="Background: Smartphone-based dating apps are rapidly transforming how people seek potential sexual and romantic partners. However, they can also increase the risk of unsafe sexual behaviors, harassment, and infringement of personal privacy. Current research on interventions for safer dating app use remains insufficient. Objective: The goal of this study was to describe the development of an intervention for safer dating app usage using crowdsourcing and peer-led approaches. Methods: This paper describes the development of an intervention program designed to promote safer dating app use among college students. Crowdsourcing and peer-led approaches were adopted during key stages of the development process. Focus group discussions were held to assess the experience and needs of dating app users. A crowdsourcing contest then solicited ideas for performance objectives for the intervention. These objectives were grouped to further identify practical strategies. A one-day intensive workshop was subsequently held with peer mentors to brainstorm ideas for the production of creative interventional materials. The intervention programs were produced and tested in a pilot study. The app's effectiveness will be evaluated in a cluster randomized controlled trial. Results: The intervention program consists of a risk assessment tool, a first-person scenario game, and four short videos. The risk assessment tool, comprised of 14 questions, will give the participant a score to determine their level of risk of adverse events when using dating apps. The scenario game is a first-person simulation game where the players are presented with choices when faced with different scenarios. The short videos each last 2-4 minutes, with points of discussion aimed at addressing the risks of using dating apps. The programs were piloted and were found to be relatable and helpful when further modifications were made. Conclusions: Potential challenges identified during the development process included data management and analysis, sustaining peer mentors' interests and participation, and balancing between providing more information and perpetuating social stigma around dating app use. By integrating new approaches, such as crowdsourcing and the peer-led approach, in developing an intervention for safer dating app use, our development process provides a viable model for developing future interventions to address the risks associated with dating app use. ",
doi="10.2196/12098",
url="http://formative.jmir.org/2020/4/e12098/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32314975"
}


@Article{info:doi/10.2196/13746,
author="Seidling, Marita Hanna
and Mahler, Cornelia
and Strau{\ss}, Beate
and Weis, Aline
and St{\"u}tzle, Marion
and Krisam, Johannes
and 
and Szecsenyi, Joachim
and Haefeli, Emil Walter",
title="An Electronic Medication Module to Improve Health Literacy in Patients With Type 2 Diabetes Mellitus: Pilot Randomized Controlled Trial",
journal="JMIR Form Res",
year="2020",
month="Apr",
day="28",
volume="4",
number="4",
pages="e13746",
keywords="medication self-management",
keywords="patient empowerment",
keywords="health literacy",
keywords="chronic diseases",
keywords="type 2 diabetes mellitus",
keywords="electronic health record",
keywords="PEPA",
keywords="electronic medication module",
keywords="structured medication review",
abstract="Background: In primary care, patients play a crucial role in managing care processes and handling drug treatment. A decisive factor for success is their health literacy, and several interventions have been introduced to support patients in fulfilling their responsibility. Objective: The aim of this study is to assess the influence of such an intervention (ie, a medication module) within a patient-led electronic health record on patients' health literacy. Methods: We conducted a randomized controlled study among community-dwelling patients with type 2 diabetes mellitus. Patients were recruited from primary care practices. After randomization, patients either had access to an internet-based medication module allowing them to store their medication information, look up drug information, and print a medication schedule (intervention group), or they received an information brochure on the importance of medication schedules (control group). After 4-8 weeks, all patients were invited to attend a structured medication review (ie, follow-up visit). Data were collected via questionnaires before the start of the intervention and during the follow-up visit. The main outcome measure was the mean difference in health literacy between baseline and follow-up assessments of patients in the control and intervention groups. Results: Of 116 recruited patients, 107 (92.2\%) completed the follow-up assessment and were eligible for intention-to-treat analyses. Only 73 patients, of which 29 were in the intervention group, followed the study protocol and were eligible for per-protocol analysis. No differences in overall health literacy were observed in either the intention-to-treat or in the per-protocol cohorts. Reasons for a null effect might be that the cohort was not particularly enriched with participants with low health literacy, thus precluding measurable improvement (ie, ceiling effect). Moreover, the success of implementation was considered poor because both the correct application of the study procedure (ie, randomization according to the protocol and dropout of 29 patients) and the actual interaction with the medication module was modest (ie, dropout of 9 patients). Conclusions: The conduct of this randomized controlled study was challenging, leaving it open whether inadequate implementation, too short of a duration, or insufficient efficacy of the intervention, as such, contributed to the null effect of this study. This clearly outlines the value of piloting complex interventions and the accompanying process evaluations. ",
doi="10.2196/13746",
url="http://formative.jmir.org/2020/4/e13746/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32343246"
}


@Article{info:doi/10.2196/14508,
author="Fortunato, Michael
and Adusumalli, Srinath
and Chokshi, Neel
and Harrison, Joseph
and Rareshide, Charles
and Patel, Mitesh",
title="Usability of Wearable Devices to Remotely Monitor Sleep Patterns Among Patients With Ischemic Heart Disease: Observational Study",
journal="JMIR Form Res",
year="2020",
month="Apr",
day="7",
volume="4",
number="4",
pages="e14508",
keywords="sleep",
keywords="wearable devices",
keywords="ischemic heart disease",
abstract="Background: There is growing interest in using wearable devices to remotely monitor patient behaviors. However, there has been little evaluation of how often these technologies are used to monitor sleep patterns over longer term periods, particularly among more high-risk patients. Objective: The goal of the research was to evaluate the proportion of time that patients with ischemic heart disease used wearable devices to monitor their sleep and identify differences in characteristics of patients with higher versus lower use. Methods: We evaluated wearable device data from a previously conducted clinical trial testing the use of wearable devices with personalized goal-setting and financial incentives. Patients with ischemic heart disease established a sleep baseline and were then followed for 24 weeks. The proportion of days that sleep data was collected was compared over the 24 weeks and by study arm. Characteristics of patients were compared to groups with high, low, or no sleep data. Results: The sample comprised 99 patients with ischemic heart disease, among which 79\% (78/99) used the wearable device to track their sleep. During the 6-month trial, sleep data were collected on 60\% (10,024/16,632) of patient-days. These rates declined over time from 77\% (4292/5544) in months 1 and 2 to 58\% (3188/5544) in months 3 and 4 to 46\% (2544/5544) in months 5 and 6. Sleep data were collected at higher rates among the intervention group compared with control (67\% vs 55\%, P<.001). In the main intervention period (months 3 and 4), patients with higher rates of sleep data were on average older (P=.03), had a history of smoking (P=.007), and had higher rates of commercial health insurance (P=.03). Conclusions: Among patients with ischemic heart disease in a physical activity trial, a high proportion used wearable devices to track their sleep; however, rates declined over time. Future research should consider larger evaluations coupled with behavioral interventions. Trial Registration: ClinicalTrials.gov NCT02531022; https://clinicaltrials.gov/ct2/show/NCT02531022 ",
doi="10.2196/14508",
url="https://formative.jmir.org/2020/4/e14508",
url="http://www.ncbi.nlm.nih.gov/pubmed/32254044"
}


@Article{info:doi/10.2196/16151,
author="Nicklas, M. Jacinda
and Leiferman, A. Jenn
and Lockhart, Steven
and Daly, M. Kristen
and Bull, S. Sheana
and Barbour, A. Linda",
title="Development and Modification of a Mobile Health Program to Promote Postpartum Weight Loss in Women at Elevated Risk for Cardiometabolic Disease: Single-Arm Pilot Study",
journal="JMIR Form Res",
year="2020",
month="Apr",
day="9",
volume="4",
number="4",
pages="e16151",
keywords="mobile health",
keywords="postpartum",
keywords="chronic disease",
keywords="prevention",
keywords="weight loss",
abstract="Background: Pregnancy complications in combination with postpartum weight retention lead to significant risks of cardiometabolic disease and obesity. The majority of traditional face-to-face interventions have not been effective in postpartum women. Mobile technology enables the active engagement of postpartum women to promote lifestyle changes to prevent chronic diseases. Objective: We sought to employ an interactive, user-centered, and participatory method of development, evaluation, and iteration to design and optimize the mobile health (mHealth) Fit After Baby program. Methods: For the initial development, a multidisciplinary team integrated evidence-based approaches for health behavior, diet and physical activity, and user-centered design and engagement. We implemented an iterative feedback and design process via 3 month-long beta pilots in which postpartum women with cardiometabolic risk factors participated in the program and provided weekly and ongoing feedback. We also conducted two group interviews using a structured interview guide to gather additional feedback. Qualitative data were recorded, transcribed, and analyzed using established qualitative methods. Modifications based on feedback were integrated into successive versions of the app. Results: We conducted three pilot testing rounds with a total of 26 women. Feedback from each pilot cohort informed changes to the functionality and content of the app, and then a subsequent pilot group participated in the program. We optimized the program in response to feedback through three iterations leading to a final version. Conclusions: This study demonstrates the feasibility of using an interactive, user-centered, participatory method of rapid, iterative design and evaluation to develop and optimize a mHealth intervention program for postpartum women. Trial Registration: ClinicalTrials.gov NCT02384226; https://www.clinicaltrials.gov/ct2/show/NCT02384226 ",
doi="10.2196/16151",
url="https://formative.jmir.org/2020/4/e16151",
url="http://www.ncbi.nlm.nih.gov/pubmed/32271149"
}


@Article{info:doi/10.2196/14747,
author="Zeisler, Marie-Luise
and Bilgic, Leman
and Schumann, Maria
and Wengler, Annelene
and Lemcke, Johannes
and G{\"o}{\ss}wald, Antje
and Lampert, Thomas
and Santos-H{\"o}vener, Claudia
and Schmich, Patrick",
title="Interventions to Increase the Reachability of Migrants in Germany With Health Interview Surveys: Mixed-Mode Feasibility Study",
journal="JMIR Form Res",
year="2020",
month="Apr",
day="15",
volume="4",
number="4",
pages="e14747",
keywords="transients and migrants",
keywords="surveys and questionnaires",
keywords="cross-sectional studies",
keywords="feasibility studies",
keywords="multilingualism and health monitoring",
abstract="Background: Germany is a popular destination for immigrants, and migration has increased in recent years. It is therefore important to collect reliable data on migrants' health. The Robert Koch Institute, Berlin, Germany, has launched the Improving Health Monitoring in Migrant Populations (IMIRA) project to sustainably integrate migrant populations into health monitoring in Germany. Objective: One of IMIRA's objectives is to implement a feasibility study (the IMIRA survey) that focuses on testing various interventions to increase the reachability of migrants with health interview surveys. Possible causes of nonresponse should be identified so as to increase participation in future surveys. Methods: The survey target populations were Turkish, Polish, Romanian, Syrian, and Croatian migrants, who represent the biggest migrant groups living in Germany. We used probability sampling, using data from the registration offices in 2 states (Berlin and Brandenburg); we randomly selected 9068 persons by nationality in 7 sample points. We applied age (3 categories: 18-44, 45-64, and ?65 years) and sex strata. Modes and methods used to test their usability were culturally sensitive materials, online questionnaires, telephone interviews, personal contact, and personal interviews, using multilingual materials and interviewers. To evaluate the effectiveness of the interventions, we used an intervention group (group A) and a control group (group B). There were also focus groups with the interviewers to get more information about the participants' motivation. We used the European Health Interview Survey, with additional instruments on religious affiliation, experience of discrimination, and subjective social status. We evaluated results according to their final contact result (disposition code). Results: We collected data from January to May 2018 in Berlin and Brandenburg, Germany. The survey had an overall response rate of 15.88\% (1190/7494). However, final disposition codes varied greatly with regard to citizenship. In addition to the quantitative results, interviewers reported in the focus groups a ``feeling of connectedness'' to the participants due to the multilingual interventions. The interviewers were particularly positive about the home visits, because ``if you are standing at the front door, you will be let in for sure.'' Conclusions: The IMIRA survey appraised the usability of mixed-mode or mixed-method approaches among migrant groups with a probability sample in 2 German states. When conducting the survey, we were confronted with issues regarding the translation of the questionnaire, as well as the validity of some instruments in the survey languages. A major result was that personal face-to-face contact was the most effective intervention to recruit our participants. We will implement the findings in the upcoming health monitoring study at the Robert Koch Institute. ",
doi="10.2196/14747",
url="https://formative.jmir.org/2020/4/e14747",
url="http://www.ncbi.nlm.nih.gov/pubmed/32305950"
}


@Article{info:doi/10.2196/17429,
author="Held, Philip
and Boley, A. Randy
and Faig, G. Walter
and O'Toole, A. John
and Desai, Imran
and Zalta, K. Alyson
and Khan, Jawad
and Sims, Shannon
and Brennan, B. Michael
and Van Horn, Rebecca
and Glover, C. Angela
and Hota, N. Bala
and Patty, D. Brian
and Rab, Shafiq S.
and Pollack, H. Mark
and Karnik, S. Niranjan",
title="The Postencounter Form System: Viewpoint on Efficient Data Collection Within Electronic Health Records",
journal="JMIR Form Res",
year="2020",
month="Apr",
day="6",
volume="4",
number="4",
pages="e17429",
keywords="electronic health record",
keywords="data collection",
keywords="veterans",
doi="10.2196/17429",
url="https://formative.jmir.org/2020/4/e17429",
url="http://www.ncbi.nlm.nih.gov/pubmed/32250276"
}