@Article{info:doi/10.2196/20658, author="Louw, Gidion Jacobus and van Heerden, Alastair and Olivier, Leana and Lambrechts, Tersius and Broodryk, Mandi and Bunge, Liska and Vosloo, Martl{\'e} and Tomlinson, Mark", title="Executive Function After Prenatal Alcohol Exposure in Children in a South African Population: Cross-sectional Study", journal="JMIR Form Res", year="2021", month="Jul", day="2", volume="5", number="7", pages="e20658", keywords="fetal alcohol spectrum disorders", keywords="FASD", keywords="cognitive", keywords="executive function", keywords="experimental games", keywords="brain drug effects", keywords="child development", keywords="serious games", keywords="games", keywords="alcohol", keywords="training", abstract="Background: Alcohol is a teratogen; its consumption during pregnancy can lead to negative birth outcomes, collectively referred to as fetal alcohol spectrum disorders. Neurodevelopmental delays in higher-order cognitive functions that affect development of executive functions are a common feature. Studies on executive function in children have focused on children diagnosed with fetal alcohol spectrum disorder, and there is a lack of information on the impact on children not diagnosed with fetal alcohol spectrum disorder but who had been exposed to alcohol. Objective: The aim of this study was to compare the development of executive function in children between 4 and 6 years of age with and without prenatal exposure to alcohol. Methods: Children both exposed and not exposed to alcohol were recruited as part of a feasibility RCT evaluating a computer-based cognitive training program for improving executive function development. The study was conducted in a low--socioeconomic status community in South Africa with a high prevalence of fetal alcohol spectrum disorder. Neurodevelopment was assessed in participating children; NEPSY-II standardized scores for executive function domains were compared using a multivariate analysis of variance with group membership as the predictor variable. Results: No significant differences in executive functions assessments (P=.39) were found between children in the alcohol-exposed group (n=76) and those in the nonexposed group (n=40). Both groups showed moderate to severe delays in domains. In all but one subtest, the average score for both groups was below the 25th percentile of expected norms. Conclusions: We expected that alcohol exposure would have a measurable impact on executive function development. The lack of differences highlights the prevalence of developmental delays in low--socioeconomic status communities in South Africa and suggests that children are exposed to various threats to cognitive development. International Registered Report Identifier (IRRID): RR2-10.2196/14489 ", doi="10.2196/20658", url="https://formative.jmir.org/2021/7/e20658", url="http://www.ncbi.nlm.nih.gov/pubmed/34255647" } @Article{info:doi/10.2196/25285, author="Valaitis, Ruta and Cleghorn, Laura and Vassilev, Ivaylo and Rogers, Anne and Ploeg, Jenny and Kothari, Anita and Risdon, Cathy and Gillett, James and Guenter, Dale and Dolovich, Lisa", title="A Web-Based Social Network Tool (GENIE) for Supporting Self-management Among High Users of the Health Care System: Feasibility and Usability Study", journal="JMIR Form Res", year="2021", month="Jul", day="12", volume="5", number="7", pages="e25285", keywords="web-based tool", keywords="usability", keywords="feasibility", keywords="self-management", keywords="social network", keywords="primary care", keywords="health and social services", keywords="linkages", keywords="high systems users", keywords="volunteers", abstract="Background: Primary care providers are well positioned to foster self-management through linking patients to community-based health and social services (HSSs). This study evaluated a web-based tool---GENIE (Generating Engagement in Network Involvement)---to support the self-management of adults. GENIE empowers patients to leverage their personal social networks and increase their access to HSSs. GENIE maps patients' personal social networks, elicits preferences, and filters local HSSs from a community service directory based on patient's interests. Trained volunteers (an extension of the primary care team) conducted home visits and conducted surveys related to life and health goals in the context of the Health TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) program, in which the GENIE tool was implemented. GENIE reports were uploaded to an electronic medical record for care planning by the team. Objective: This study aims to explore patients', volunteers', and clinicians' perceptions of the feasibility, usability, and perceived outcomes of GENIE---a tool for community-dwelling adults who are high users of the health care system. Methods: This study involved 2 primary care clinician focus groups and 1 clinician interview (n=15), 1 volunteer focus group (n=3), patient telephone interviews (n=8), field observations that captured goal-action sequences to complete GENIE, and GENIE utilization statistics. The patients were enrolled in a primary care program---Health TAPESTRY---and Ontario's Health Links Program, which coordinates care for the highest users of the health care system. NVivo 11 (QSR International) was used to support qualitative data analyses related to feasibility and perceived outcomes, and descriptive statistics were used for quantitative data. Results: Most participants reported positive overall perceptions of GENIE. However, feasibility testing showed that participants had a partial understanding of the tool; volunteer facilitation was critical to support the implementation of GENIE; clinicians perceived their navigation ability as superior to that of GENIE supported by volunteers; and tool completion took 39 minutes, which made the home visit too long for some. Usability challenges included difficulties completing some sections of the tool related to medical terminology and unclear instructions, limitations in the quality and quantity of HSSs results, and minor technological challenges. Almost all patients identified a community program or activity of interest. Half of the patients (4/8, 50\%) followed up on HSSs and added new members to their network, whereas 1 participant lost a member. Clinicians' strengthened their understanding of patients' personal social networks and needs, and patients felt less social isolation. Conclusions: This study demonstrated the potential of GENIE, when supported by volunteers, to expand patients' social networks and link them to relevant HSSs. Volunteers require training to implement GENIE for self-management support, which may help overcome the time limitations faced by primary care clinicians. Refining the filtering capability of GENIE to address adults' needs may improve primary care providers' confidence in using such tools. ", doi="10.2196/25285", url="https://formative.jmir.org/2021/7/e25285", url="http://www.ncbi.nlm.nih.gov/pubmed/34255654" } @Article{info:doi/10.2196/20969, author="Bhattacharya, Arpita and Nagar, Ria and Jenness, Jessica and Munson, A. Sean and Kientz, A. Julie", title="Designing Asynchronous Remote Support for Behavioral Activation in Teenagers With Depression: Formative Study", journal="JMIR Form Res", year="2021", month="Jul", day="13", volume="5", number="7", pages="e20969", keywords="teens", keywords="mental health", keywords="behavioral activation", keywords="asynchronous remote communities", abstract="Background: Many teenagers in the United States experience challenges with symptoms of depression, and they lack adequate resources for accessing in-person mental health care. Involving teens and clinicians in designing technologies that use evidence-based practices that reduce barriers to accessing mental health care is crucial. Interventions based on behavioral activation (BA) help teens understand the relationship between mood and activity, help them practice goal-directed behaviors to improve mood, and may be particularly well-suited to delivery via internet-based platforms. Objective: This study aims to understand the needs and challenges that teens and mental health clinicians face in depression management and involve them in the design process of a remote intervention that uses asynchronous remote communities. Our goal is to understand the benefits and challenges of adapting BA to an internet-based platform that supports the asynchronous remote community approach as a delivery tool for teen depression management. Methods: We enrolled mental health clinicians (n=10) and teens (n=8) in separate, private, internet-based groups on Slack (Slack Technologies Inc). They participated in 20-minute design activities for 10 weeks and were then invited to interviews about their experiences in the study. Results: Both teen and clinician participants wanted internet-based support for BA as a supplement to in-person therapy. Although participants perceived the asynchronous format as conducive to supporting accessible care, teens and clinicians raised concerns about safety, privacy, and the moderating of the internet-based group. Design decisions that address these concerns need to be balanced with the potential benefits of learning coping skills, increasing access to mental health care, and promoting asynchronous human connection to support teens. Conclusions: We discuss considerations for balancing tensions in privacy and safety while designing and selecting internet-based platforms to support remote care and integrating evidence-based support when designing digital technologies for the treatment of teens with depression. ", doi="10.2196/20969", url="https://formative.jmir.org/2021/7/e20969", url="http://www.ncbi.nlm.nih.gov/pubmed/34255665" } @Article{info:doi/10.2196/27327, author="Corbett, F. Cynthia and Combs, M. Elizabeth and Chandarana, S. Peyton and Stringfellow, Isabel and Worthy, Karen and Nguyen, Thien and Wright, J. Pamela and O'Kane, M. Jason", title="Medication Adherence Reminder System for Virtual Home Assistants: Mixed Methods Evaluation Study", journal="JMIR Form Res", year="2021", month="Jul", day="13", volume="5", number="7", pages="e27327", keywords="medication adherence", keywords="medication", keywords="virtual home assistants", keywords="virtual assistant", keywords="public health", keywords="health care costs", keywords="Echo device", keywords="device usability", keywords="digital health", keywords="mobile phone", abstract="Background: Medication nonadherence is a global public health challenge that results in suboptimal health outcomes and increases health care costs. Forgetting to take medicines is one of the most common reasons for unintentional medication nonadherence. Research findings indicate that voice-activated virtual home assistants, such as Amazon Echo and Google Home devices, may be useful in promoting medication adherence. Objective: This study aims to create a medication adherence app (skill), MedBuddy, for Amazon Echo devices and measure the use, usability, and usefulness of this medication-taking reminder skill. Methods: A single-group, mixed methods, cohort feasibility study was conducted with women who took oral contraceptives (N=25). Participants were undergraduate students (age: mean 21.8 years, SD 6.2) at an urban university in the Southeast United States. Participants were given an Amazon Echo Dot with MedBuddy---a new medication reminder skill for Echo devices created by our team---attached to their study account, which they used for 60 days. Participants self-reported their baseline and poststudy medication adherence. MedBuddy use was objectively evaluated by tracking participants' interactions with MedBuddy through Amazon Alexa. The usability and usefulness of MedBuddy were evaluated through a poststudy interview in which participants responded to both quantitative and qualitative questions. Results: Participants' interactions with MedBuddy, as tracked through Amazon Alexa, only occurred on half of the study days (mean 50.97, SD 29.5). At study end, participants reported missing their medication less in the past 1 and 6 months compared with baseline ($\chi$21=0.9 and $\chi$21=0.4, respectively; McNemar test: P<.001 for both). However, there was no significant difference in participants' reported adherence to consistently taking medication within the same 2-hour time frame every day in the past 1 or 6 months at the end of the study compared with baseline ($\chi$21=3.5 and $\chi$21=0.4, respectively; McNemar test: P=.63 and P=.07, respectively). Overall feedback about usability was positive, and participants provided constructive feedback about the skill's features that could be improved. Participants' evaluation of MedBuddy's usefulness was overwhelmingly positive---most (15/23, 65\%) said that they would continue using MedBuddy as a medication reminder if provided with the opportunity and that they would recommend it to others. MedBuddy features that participants enjoyed were an external prompt separate from their phone, the ability to hear the reminder prompt from a separate room, multiple reminders, and verbal responses to prompts. Conclusions: The findings of this feasibility study indicate that the MedBuddy medication reminder skill may be useful in promoting medication adherence. However, the skill could benefit from further usability enhancements. ", doi="10.2196/27327", url="https://formative.jmir.org/2021/7/e27327", url="http://www.ncbi.nlm.nih.gov/pubmed/34255669" } @Article{info:doi/10.2196/22510, author="Resnick, Daniel and Schapira, M. Marilyn and Smith, M. Jazmine and Bautista, Allison and Xu, Chang and Jones, Liz and Aysola, Jaya", title="Promoting Collaborative Goal Setting for Cancer Prevention Among Primary Care Patients Through mHealth: Mixed Methods Evaluation of a New App", journal="JMIR Form Res", year="2021", month="Jul", day="14", volume="5", number="7", pages="e22510", keywords="mHealth", keywords="cancer prevention", keywords="goal setting", keywords="social networks", keywords="health disparities", keywords="mobile phone", abstract="Background: Many newly diagnosed cancers are associated with modifiable lifestyle behaviors, such as diet, exercise, smoking cessation, and maintaining a healthy weight. However, primary care providers rarely discuss cancer prevention behaviors with their patients. Objective: This study aims to assess the usability, acceptability, and user engagement of the Healthier Together mobile app, which is designed to promote cancer prevention behaviors among non-Hispanic Black primary care patients, by using social networks and goal-setting theories of behavior change. Methods: In an 8-week pilot study, we enrolled primary care patients (N=41) and provided them with a cancer prevention mobile app that allowed them to select, track, and share progress on cancer prevention goals with other users. App usability was assessed using the System Usability Scale. We assessed the app's acceptability by qualitatively analyzing open-ended responses regarding participants' overall experience with the app. We assessed participants' engagement by analyzing the built-in data capture device, which included the number of times participants checked in (out of a maximum of 8) during the study. Results: The mean age of the 41 participants was 51 years (SD 12), and 76\% (31/41) were women. App use data were captured from all participants, and 83\% (34/41) completed the exit survey and interview. The mean System Usability Scale score was 87 (SD 12; median 90; IQR 78-95). The analysis of open-ended responses revealed several key themes, and participants complemented the app's ease of use and health behavior--promoting features while also commenting on the need for more feedback and social interactions through the app. On average, participants checked in 5.7 times (SD 2.7) out of 8 possible opportunities. Of the 41 participants, 76\% (31/41) checked in during at least 4 of the 8 weeks. Secondary analyses revealed that participants often accomplished their set goals (mean 5.1, SD 2.7) for each week. The qualitative analysis of comments given by participants within the app after each weekly check-in revealed several themes on how the app assisted participants in behavioral change, highlighting that some participants created exercise programs, ate healthier foods, lost a significant amount of weight, and stopped smoking during this study. Conclusions: The implementation of a mobile cancer prevention goal--setting app in a primary care setting was feasible, and the app achieved high usability, acceptability, and engagement among participants. User feedback revealed an influence on health behaviors. These findings suggest the promise of the Healthier Together app in facilitating behavioral change to reduce cancer risk among non-Hispanic Black primary care patients. ", doi="10.2196/22510", url="https://formative.jmir.org/2021/7/e22510", url="http://www.ncbi.nlm.nih.gov/pubmed/34259162" } @Article{info:doi/10.2196/27018, author="Wilks, R. Chelsey and Chu, Carol and Sim, DongGun and Lovell, Josh and Gutierrez, Peter and Joiner, Thomas and Kessler, C. Ronald and Nock, K. Matthew", title="User Engagement and Usability of Suicide Prevention Apps: Systematic Search in App Stores and Content Analysis", journal="JMIR Form Res", year="2021", month="Jul", day="14", volume="5", number="7", pages="e27018", keywords="suicide", keywords="mHealth", keywords="usability", keywords="engagement", keywords="mobile phone", abstract="Background: People with suicidal thoughts are more inclined to seek technology-delivered interventions than in-person forms of treatment, making mobile apps for suicide prevention an ideal platform for treatment delivery. This review examines apps designed for suicide prevention, with a specific focus on user engagement. Objective: This study aims to update the literature and broadly evaluate the landscape of mobile health apps for suicide prevention; examine apps with key features and primary approaches to suicide prevention; and systematically evaluate the engagement, functionality, aesthetics, and information of the apps. Methods: All apps related to suicidal thoughts and behaviors were identified in the Google Play and iOS app stores and were systematically reviewed for their content and quality. The mobile app rating scale (MARS) was used to evaluate app usability and engagement. Results: Of the 66 apps identified, 42 (64\%) were specifically designed for people with suicidal ideation, and 59 (89\%) had at least one best practice feature for suicide risk reduction. The mean overall MARS score of all apps was 3.5 (range 2.1-4.5), with 83\% (55/66) of apps having a minimum acceptability score of 3. The total MARS score was not associated with the user app rating (r=?0.001; P=.99) or the number of features (r=0.24; P=.09). Conclusions: This study identified many usable and engaging apps in app stores designed for suicide prevention. However, there are only limited apps for clinicians. Thus, mobile apps for suicide prevention should be carefully developed and clinically evaluated. ", doi="10.2196/27018", url="https://formative.jmir.org/2021/7/e27018", url="http://www.ncbi.nlm.nih.gov/pubmed/34259163" } @Article{info:doi/10.2196/16949, author="Eccles, Heidi and Nannarone, Molly and Lashewicz, Bonnie and Attridge, Mark and Marchand, Alain and Aiken, Alice and Ho, Kendall and Wang, JianLi", title="Barriers to the Use of Web-Based Mental Health Programs for Preventing Depression: Qualitative Study", journal="JMIR Form Res", year="2021", month="Jul", day="15", volume="5", number="7", pages="e16949", keywords="prevention", keywords="mental health", keywords="depression", keywords="problem solving therapy", keywords="barriers", keywords="web-based program", keywords="qualitative study", abstract="Background: Depression has a profound impact on population health. Although using web-based mental health programs to prevent depression has been found to be effective in decreasing depression incidence, there are obstacles preventing their use, as reflected by the low rates of use and adherence. Objective: The aims of the study are to understand the barriers to using web-based mental health programs for the prevention of depression and the possible dangers or concerns regarding the use of such programs. Methods: BroMatters and HardHat were two randomized controlled trials (RCTs) that evaluated the effectiveness of e--mental health programs for preventing workplace depression. In the BroMatters RCT, only working men who were at high risk of having a major depressive episode were included. The participants were assigned to either the control group or 1 of 2 intervention groups. The control participants had access to the general depression information on the BroMatters website. Intervention group 1 had access to BroMatters and BroHealth---the depression prevention program. Intervention group 2 had access to BroMatters and BroHealth along with weekly access to a qualified coach through telephone calls. The HardHat trial targeted both men and women at high risk of having a major depressive episode. The participants in the intervention group were given access to the HardHat depression prevention program (which included a web-based coach), whereas HardHat access was only granted to the control group once the study was completed. This qualitative study recruited male participants from the intervention groups of the two RCTs. A total of 2 groups of participants were recruited from the BroMatters study (after a baseline interview: n=41; 1 month after the RCT: n=20; 61/744, 8.2\%), and 1 group was recruited from the HardHat RCT 1 month after the initial quantitative interview (9/103, 8.7\%). Semistructured interviews were performed with the participants (70/847, 8.3\%) and analyzed using content analysis. Results: There were both personal and program-level barriers to program use. The three personal barriers included time, stress level, and the perception of depression prevention. Content, functionality, and dangers were the program-level barriers to the use of web-based mental health programs. Large amounts of text and functionality issues within the programs decreased participants' engagement. The dangers associated with web-based mental health programs included privacy breaches and inadequate help for severe symptoms. Conclusions: There are personal and program-level barriers to the use of web-based mental health programs. The stigmatization of help seeking for depression symptoms affects the time spent on the program, as does the public perception of depression. Certain barriers may be mitigated by program updates, whereas others may require a complete shift in the perception of depression prevention. ", doi="10.2196/16949", url="https://formative.jmir.org/2021/7/e16949", url="http://www.ncbi.nlm.nih.gov/pubmed/34264195" } @Article{info:doi/10.2196/23242, author="Batra, Nikita and Colson, D. Cindy and Alberto, C. Emily and Burd, S. Randall", title="Using Social Media for the Prevention of Pediatric Burn Injuries: Pilot Design and Usability Study", journal="JMIR Form Res", year="2021", month="Jul", day="15", volume="5", number="7", pages="e23242", keywords="accident prevention", keywords="burns", keywords="pediatric", keywords="public health", keywords="social media", abstract="Background: Most pediatric burn injuries are preventable. Social media is an effective method for delivering large-scale messaging and may be useful for injury prevention in this domain. Objective: This study evaluates the feasibility of creating a social media campaign for pediatric burn injury prevention. Methods: Ad spots containing a headline, short introduction, and video were created and posted on Facebook and Instagram over 4 months. Ad spots were targeted to parents and caregivers of children in our region with the highest number of burn injuries. We assessed the impact of each ad set using ThruPlays, reach, and video plays. Results: We created 55 ad spots, with an average length of 24.1 (range 10-44) seconds. We reached 26,496 people during the campaign. The total ThruPlays of the 55 ad spots were 14,460 at US \$0.19 per ThruPlay. Ad spots related to home safety had a significantly higher daily ThruPlay rate than those related to fire safety (6.5 vs 0.5 per day; P<.001). Conclusions: Social media is a feasible modality for delivering public health messages focused on preventing pediatric burn injuries. Engagement with these ads is influenced by ad presentation and the focus of the underlying injury prevention message. ", doi="10.2196/23242", url="https://formative.jmir.org/2021/7/e23242", url="http://www.ncbi.nlm.nih.gov/pubmed/34264194" } @Article{info:doi/10.2196/22110, author="Beaubien, Louis and Conrad, Colin and Music, Janet and Toze, Sandra", title="Evaluating Simplified Web Interfaces of Risk Models for Clinical Use: Pilot Survey Study", journal="JMIR Form Res", year="2021", month="Jul", day="16", volume="5", number="7", pages="e22110", keywords="risk model", keywords="electronic records", keywords="user interface", keywords="technology acceptance", abstract="Background: In this pilot study, we investigated sociotechnical factors that affect intention to use a simplified web model to support clinical decision making. Objective: We investigated factors that are known to affect technology adoption using the unified theory of acceptance and use of technology (UTAUT2) model. The goal was to pilot and test a tool to better support complex clinical assessments. Methods: Based on the results of a previously published work, we developed a web-based mobile user interface, WebModel, to allow users to work with regression equations and their predictions to evaluate the impact of various characteristics or treatments on key outcomes (eg, survival time) for chronic obstructive pulmonary disease. The WebModel provides a way to combat information overload and more easily compare treatment options. It limits the number of web forms presented to a user to between 1 and 20, rather than the dozens of detailed calculations typically required. The WebModel uses responsive design and can be used on multiple devices. To test the WebModel, we designed a questionnaire to probe the efficacy of the WebModel and assess the usability and usefulness of the system. The study was live for one month, and participants had access to it over that time. The questionnaire was administered online, and data from 674 clinical users who had access to the WebModel were captured. SPSS and R were used for statistical analysis. Results: The regression model developed from UTAUT2 constructs was a fit. Specifically, five of the seven factors were significant positive coefficients in the regression: performance expectancy ($\beta$=.2730; t=7.994; P<.001), effort expectancy ($\beta$=.1473; t=3.870; P=.001), facilitating conditions ($\beta$=.1644; t=3.849; P<.001), hedonic motivation ($\beta$=.2321; t=3.991; P<.001), and habit ($\beta$=.2943; t=12.732). Social influence was not a significant factor, while price value had a significant negative influence on intention to use the WebModel. Conclusions: Our results indicate that multiple influences impact positive response to the system, many of which relate to the efficiency of the interface to provide clear information. Although we found that the price value was a negative factor, it is possible this was due to the removal of health workers from purchasing decisions. Given that this was a pilot test, and that the system was not used in a clinical setting, we could not examine factors related to actual workflow, patient safety, or social influence. This study shows that the concept of a simplified WebModel could be effective and efficient in reducing information overload in complex clinical decision making. We recommend further study to test this in a clinical setting and gather qualitative data from users regarding the value of the tool in practice. ", doi="10.2196/22110", url="https://formative.jmir.org/2021/7/e22110", url="http://www.ncbi.nlm.nih.gov/pubmed/34269692" } @Article{info:doi/10.2196/27484, author="Shojaie, Danielle and Hoffman, S. Aubri and Amaku, Ruth and Cabanillas, E. Maria and Sosa, Ann Julie and Waguespack, G. Steven and Zafereo, E. Mark and Hu, I. Mimi and Grubbs, E. Elizabeth", title="Decision Making When Cancer Becomes Chronic: Needs Assessment for a Web-Based Medullary Thyroid Carcinoma Patient Decision Aid", journal="JMIR Form Res", year="2021", month="Jul", day="16", volume="5", number="7", pages="e27484", keywords="patient decision aids", keywords="decision support techniques", keywords="oncology", keywords="medullary thyroid cancer", keywords="targeted therapy", keywords="clinical trial", keywords="mobile phone", abstract="Background: In cancers with a chronic phase, patients and family caregivers face difficult decisions such as whether to start a novel therapy, whether to enroll in a clinical trial, and when to stop treatment. These decisions are complex, require an understanding of uncertainty, and necessitate the consideration of patients' informed preferences. For some cancers, such as medullary thyroid carcinoma, these decisions may also involve significant out-of-pocket costs and effects on family members. Providers have expressed a need for web-based interventions that can be delivered between consultations to provide education and prepare patients and families to discuss these decisions. To ensure that these tools are effective, usable, and understandable, studies are needed to identify patients', families', and providers' decision-making needs and optimal design strategies for a web-based patient decision aid. Objective: Following the international guidelines for the development of a web-based patient decision aid, the objectives of this study are to engage potential users to guide development; review the existing literature and available tools; assess users' decision-making experiences, needs, and design recommendations; and identify shared decision-making approaches to address each need. Methods: This study used the decisional needs assessment approach, which included creating a stakeholder advisory panel, mapping decision pathways, conducting an environmental scan of existing materials, and administering a decisional needs assessment questionnaire. Thematic analyses identified current decision-making pathways, unmet decision-making needs, and decision support strategies for meeting each need. Results: The stakeholders reported wide heterogeneity in decision timing and pathways. Relevant existing materials included 2 systematic reviews, 9 additional papers, and multiple educational websites, but none of these met the criteria for a patient decision aid. Patients and family members (n=54) emphasized the need for plain language (46/54, 85\%), shared decision making (45/54, 83\%), and help with family discussions (39/54, 72\%). Additional needs included information about uncertainty, lived experience, and costs. Providers (n=10) reported needing interventions that address misinformation (9/10, 90\%), foster realistic expectations (9/10, 90\%), and address mistrust in clinical trials (5/10, 50\%). Additional needs included provider tools that support shared decision making. Both groups recommended designing a web-based patient decision aid that can be tailored to (64/64, 100\%) and delivered on a hospital website (53/64, 83\%), focuses on quality of life (45/64, 70\%), and provides step-by-step guidance (43/64, 67\%). The study team identified best practices to meet each need, which are presented in the proposed decision support design guide. Conclusions: Patients, families, and providers report multifaceted decision support needs during the chronic phase of cancer. Web-based patient decision aids that provide tailored support over time and explicitly address uncertainty, quality of life, realistic expectations, and effects on families are needed. ", doi="10.2196/27484", url="https://formative.jmir.org/2021/7/e27484", url="http://www.ncbi.nlm.nih.gov/pubmed/34269691" } @Article{info:doi/10.2196/25796, author="Miguel, Andre and Smith, Crystal and Perea, Nicole and Johnson, Kim and McDonell, Michael and McPherson, Sterling", title="Development of Automated Reinforcement Management System (ARMS): Protocol for a Phase I Feasibility and Usability Study", journal="JMIR Form Res", year="2021", month="Jul", day="19", volume="5", number="7", pages="e25796", keywords="alcohol use disorder", keywords="contingency management", keywords="ecological momentary assessment", keywords="treatment", abstract="Background: Alcohol use is directly related to over 3 million deaths worldwide every year. Contingency management is a cost-effective treatment for substance use disorders; however, few studies have examined its efficacy for alcohol use disorder. Recent technological advances have enabled the combined use of mobile apps and low-cost electronic breathalyzer devices to remotely monitor alcohol use. Leveraging this type of technology, our study group has recently developed an integrated contingency management system that would enable community treatment programs to remotely deliver contingency management to anyone who owns a smartphone. Objective: In this paper, we present a full description of our integrated contingency management system, Automated Reinforcement Management System (ARMS), and describe a protocol that will evaluate its feasibility and usability. Methods: Initially, 6 clinicians will participate in a 1-hour focus group where the study staff will navigate through ARMS as it would be used by clinicians and patients. Clinicians will provide feedback on the intervention in general, which will be used to modify ARMS to make it more user friendly, time saving, and relevant to treatment. A second focus group will summarize the changes made following the initial clinician feedback and will provide additional input regarding the potential utilization of ARMS. Thereafter, the clinicians' acceptability of ARMS will be evaluated using the System Usability Scale. Following the clinicians' assessments of ARMS and final modifications, the system will be evaluated in terms of feasibility and patient usability by using an A-B-A within-subject experimental design wherein 20 treatment-seeking individuals with alcohol use disorder will be recruited. The two A phases (control conditions) will each last 2 weeks, and the B phase (contingency management condition) will last 4 weeks. During all phases, participants will be asked to use the ARMS app to submit three breathalyzer samples per day (at 10 AM, 2 PM, and 8 PM). Participants will be prompted by the ARMS app at these predetermined times to record and submit their breathalyzer samples. During the A phases, participants will earn vouchers for every breathalyzer sample submitted, independent of their sample results. During the B phase, vouchers will be provided contingent upon the submission of alcohol-negative breathalyzer samples (breath alcohol content = 0.00). At the end of the A-B-A experiment trial, patients' usability of the ARMS app will be evaluated using the System Usability Scale. Feasibility will be measured based on whether the ARMS app helped significantly increase alcohol abstinence. Results: Recruitment for this study began in January 2021 and is expected to be completed by December 2021. Conclusions: This study will provide the baseline capability for the implementation of a remotely monitored contingency management platform. If successful, ARMS has the potential to provide effective treatment for alcohol use disorders to individuals living in remote rural areas. ", doi="10.2196/25796", url="https://formative.jmir.org/2021/7/e25796", url="http://www.ncbi.nlm.nih.gov/pubmed/34279238" } @Article{info:doi/10.2196/26059, author="Mulgund, Pavankumar and Sharman, Raj and Rifkin, Daniel and Marrazzo, Sam", title="Design, Development, and Evaluation of a Telemedicine Platform for Patients With Sleep Apnea (Ognomy): Design Science Research Approach", journal="JMIR Form Res", year="2021", month="Jul", day="19", volume="5", number="7", pages="e26059", keywords="design science research", keywords="telemedicine platform", keywords="sleep apnea care", keywords="mHealth", keywords="telemedicine", keywords="sleep apnea", keywords="mobile health", keywords="web application", keywords="mobile phone", abstract="Background: With an aging population and the escalating cost of care, telemedicine has become a societal imperative. Telemedicine alternatives are especially relevant to patients seeking care for sleep apnea, with its prevalence approaching one billion cases worldwide. Increasing awareness has led to a surge in demand for sleep apnea care; however, there is a shortage of the resources and expertise necessary to cater to the rising demand. Objective: The aim of this study is to design, develop, and evaluate a telemedicine platform, called Ognomy, for the consultation, diagnosis, and treatment of patients with sleep apnea. Methods: Using the design science research methodology, we developed a telemedicine platform for patients with sleep apnea. To explore the problem, in the analysis phase, we conducted two brainstorming workshops and structured interviews with 6 subject matter experts to gather requirements. Following that, we conducted three design and architectural review sessions to define and evaluate the system architecture. Subsequently, we conducted 14 formative usability assessments to improve the user interface of the system. In addition, 3 trained test engineers performed end-to-end system testing to comprehensively evaluate the platform. Results: Patient registration and data collection, physician appointments, video consultation, and patient progress tracking have emerged as critical functional requirements. A telemedicine platform comprising four artifacts---a mobile app for patients, a web app for providers, a dashboard for reporting, and an artificial intelligence--based chatbot for customer onboarding and support---was developed to meet these requirements. Design reviews emphasized the need for a highly cohesive but loosely coupled interaction among the platform's components, which was achieved through a layered modular architecture using third-party application programming interfaces. In contrast, critical findings from formative usability assessments focused on the need for a more straightforward onboarding process for patients, better status indicators during patient registration, and reorganization of the appointment calendar. Feedback from the design reviews and usability assessments was translated into technical improvements and design enhancements that were implemented in subsequent iterations. Conclusions: Sleep apnea is an underdiagnosed and undertreated condition. However, with increasing awareness, the demand for quality sleep apnea care is likely to surge, and creative alternatives are needed. The results of this study demonstrate the successful application of a framework using a design science research paradigm to design, develop, and evaluate a telemedicine platform for patients with sleep apnea and their providers. ", doi="10.2196/26059", url="https://formative.jmir.org/2021/7/e26059", url="http://www.ncbi.nlm.nih.gov/pubmed/34279237" } @Article{info:doi/10.2196/22693, author="Beres, K. Laura and Mbabali, Ismail and Anok, Aggrey and Katabalwa, Charles and Mulamba, Jeremiah and Thomas, G. Alvin and Bugos, Eva and Nakigozi, Gertrude and Grabowski, K. Mary and Chang, W. Larry", title="Mobile Ecological Momentary Assessment and Intervention and Health Behavior Change Among Adults in Rakai, Uganda: Pilot Randomized Controlled Trial", journal="JMIR Form Res", year="2021", month="Jul", day="20", volume="5", number="7", pages="e22693", keywords="ecological momentary assessment", keywords="ecological momentary intervention", keywords="mHealth", keywords="digital health", keywords="smartphone", keywords="mobile phone", keywords="randomized trial", keywords="Uganda", keywords="Africa", abstract="Background: An extraordinary increase in mobile phone ownership has revolutionized the opportunities to use mobile health approaches in lower- and middle-income countries (LMICs). Ecological momentary assessment and intervention (EMAI) uses mobile technology to gather data and deliver timely, personalized behavior change interventions in an individual's natural setting. To our knowledge, there have been no previous trials of EMAI in sub-Saharan Africa. Objective: To advance the evidence base for mobile health (mHealth) interventions in LMICs, we conduct a pilot randomized trial to assess the feasibility of EMAI and establish estimates of the potential effect of EMAI on a range of health-related behaviors in Rakai, Uganda. Methods: This prospective, parallel-group, randomized pilot trial compared health behaviors between adult participants submitting ecological momentary assessment (EMA) data and receiving behaviorally responsive interventional health messaging (EMAI) with those submitting EMA data alone. Using a fully automated mobile phone app, participants submitted daily reports on 5 different health behaviors (fruit consumption, vegetable consumption, alcohol intake, cigarette smoking, and condomless sex with a non--long-term partner) during a 30-day period before randomization (P1). Participants were then block randomized to the control arm, continuing EMA reporting through exit, or the intervention arm, EMA reporting and behavioral health messaging receipt. Participants exited after 90 days of follow-up, divided into study periods 2 (P2: randomization + 29 days) and 3 (P3: 30 days postrandomization to exit). We used descriptive statistics to assess the feasibility of EMAI through the completeness of data and differences in reported behaviors between periods and study arms. Results: The study included 48 participants (24 per arm; 23/48, 48\% women; median age 31 years). EMA data collection was feasible, with 85.5\% (3777/4418) of the combined days reporting behavioral data. There was a decrease in the mean proportion of days when alcohol was consumed in both arms over time (control: P1, 9.6\% of days to P2, 4.3\% of days; intervention: P1, 7.2\% of days to P3, 2.4\% of days). Decreases in sex with a non--long-term partner without a condom were also reported in both arms (P1 to P3 control: 1.9\% of days to 1\% of days; intervention: 6.6\% of days to 1.3\% of days). An increase in vegetable consumption was found in the intervention (vegetable: 65.6\% of days to 76.6\% of days) but not in the control arm. Between arms, there was a significant difference in the change in reported vegetable consumption between P1 and P3 (control: 8\% decrease in the mean proportion of days vegetables consumed; intervention: 11.1\% increase; P=.01). Conclusions: Preliminary estimates suggest that EMAI may be a promising strategy for promoting behavior change across a range of behaviors. Larger trials examining the effectiveness of EMAI in LMICs are warranted. Trial Registration: ClinicalTrials.gov NCT04375423; https://www.clinicaltrials.gov/ct2/show/NCT04375423 ", doi="10.2196/22693", url="https://formative.jmir.org/2021/7/e22693", url="http://www.ncbi.nlm.nih.gov/pubmed/34283027" } @Article{info:doi/10.2196/22968, author="Alshehri, Fayz and Alshaikh, Fahdah", title="Exploring the Constituent Elements of a Successful Mobile Health Intervention for Prediabetic Patients in King Saud University Medical City Hospitals in Saudi Arabia: Cross-sectional Study", journal="JMIR Form Res", year="2021", month="Jul", day="20", volume="5", number="7", pages="e22968", keywords="prediabetes", keywords="mHealth", keywords="CeHRes roadmap", keywords="Saudi Arabia", abstract="Background: Self-management of prediabetic patients is crucial since they are at high risk of developing type 2 diabetes. Mobile health (mHealth) apps could contribute to potentially reducing the burden of diabetes by supporting the self-management of prediabetic patients. Objective: This study aimed to explore the constituent elements of a successful mHealth intervention for prediabetic patients in King Saud University Medical City (KSUMC) hospitals in Saudi Arabia using the Centre for eHealth Research (CeHRes) roadmap. Methods: This study used the CeHRes roadmap as a developmental guideline for proposing mHealth app features for self-management of prediabetic patients and was performed in 3 phases with one round in each phase. First, a contextual inquiry was conducted via an online self-administered questionnaire for both health care providers and patients. Second, the value specification phase elaborated on the outcomes from the contextual inquiry phase. Finally, prototype user design was performed in cocreation with end users. The design phase was also conducted via an online self-administered questionnaire to evaluate the proposed features of mHealth apps by prediabetic patients. Results: A total of 20 health care providers participated in the study. The results revealed that the most powerful intervention for prediabetes was a combination of medication, physical activity, and healthy diet plans (12/20, 60\%). Furthermore, the most common challenge faced by prediabetes patients was patient adherence to healthy diet and physical activity recommendations (10/20, 50\%). Almost all patients believed that mHealth apps would be useful for prediabetic patients. A total of 48 prediabetic patients participated in the study. The results indicated that the most powerful intervention for prediabetic patients is a combination of healthy diet and physical activity plans (21/48, 44\%), and the most frequent challenge that may lead the patients to discontinue the current intervention was the commitment to a physical activity plan (35/48, 75\%). Furthermore, 15\% (17/48) of patients use well-being and health apps to manage their current health status. The most common difficulties faced by the patients were navigating app features (mean 2.02 [SD 1.7]) followed by the app language (mean 1.88 [SD 2.0]); these difficulties occurred at a significantly higher rate among those with secondary or lower educational levels as compared to undergraduate and postgraduate levels (P<.05). Finally, the features proposed in the prototype design scored more than 2.5 points higher and indicate the need for these features to be included in the mHealth app. Conclusions: This study aimed to provide real-world insights into the development of an mHealth app for a diabetes prevention intervention by involving both health care providers and prediabetic patients in KSUMC hospitals. Therefore, the proposed app, which comprises all necessary features, may aid patients with prediabetes in self-management and making changes in their lifestyle. ", doi="10.2196/22968", url="https://formative.jmir.org/2021/7/e22968", url="http://www.ncbi.nlm.nih.gov/pubmed/34061762" } @Article{info:doi/10.2196/26202, author="Constantinou, Heidi and Fairley, K. Christopher and Hocking, S. Jane and Bradshaw, S. Catriona and Choi, H. Edmond P. and Maddaford, Kate and Phillips, R. Tiffany and Chow, F. Eric P.", title="Associations Between Methods of Meeting Sexual Partners and Sexual Practices Among Heterosexuals: Cross-sectional Study in Melbourne, Australia", journal="JMIR Form Res", year="2021", month="Jul", day="20", volume="5", number="7", pages="e26202", keywords="internet", keywords="dating apps", keywords="mobile phone", keywords="sexually transmitted infections", keywords="health risk behaviors", abstract="Background: The association between meeting partners on the web and sexual practices has been understudied in heterosexuals. Objective: This study aims to examine the associations between the methods of meeting partners and sexual practices and HIV and sexually transmitted infections (STIs) in heterosexuals. Methods: We conducted a survey among heterosexuals attending the Melbourne Sexual Health Centre in 2019. This survey asked about the methods through which the participants engaged in meeting their sexual partners, sexual practices, and intravenous drug use (IVDU) over the past 3 months. The participants' HIV and STI (chlamydia, gonorrhea, and syphilis) status was obtained from clinical testing. Multivariable logistic regression was used to examine the association between each method of meeting and the participants' sexual practices, IVDU, and STI status. Results: A total of 698 participants (325 men and 373 women) were included in the study. Most of the participants reported using only one method to meet partners (222/325, 68.3\% men; 245/373, 65.7\% women; P=.05). The men met partners most commonly at social venues (eg, bar, pub, or party; 126/325, 38.8\%), whereas the women met partners most commonly through friends or family (178/373, 47.7\%). Paying for sex was associated with men meeting partners at sex venues (adjusted odds ratio [AOR] 145.34, 95\% CI 26.13-808.51) and on the internet (AOR 10.00, 95\% CI 3.61-27.55). There was no association between IVDU and methods of meeting. Social venues were associated with condomless vaginal sex among men (AOR 3.31, 95\% CI 1.94-5.71) and women (AOR 2.58, 95\% CI 1.61-4.13) and testing positive for STI among men (AOR 3.04, 95\% CI 1.24-7.48) and women (AOR 3.75, 95\% CI 1.58-8.89). Conclusions: Heterosexuals who met partners at social venues had a more than threefold risk of testing positive for STIs, indicating that heterosexuals may benefit from health promotion campaigns that are delivered through a public setting. ", doi="10.2196/26202", url="https://formative.jmir.org/2021/7/e26202", url="http://www.ncbi.nlm.nih.gov/pubmed/34283024" } @Article{info:doi/10.2196/28680, author="Walter, Bente and Indreboe, Hege and Lukasse, Mirjam and Henriksen, Lena and Garnweidner-Holme, Lisa", title="Pregnant Women's Attitudes Toward and Experiences With a Tablet Intervention to Promote Safety Behaviors in a Randomized Controlled Trial: Qualitative Study", journal="JMIR Form Res", year="2021", month="Jul", day="20", volume="5", number="7", pages="e28680", keywords="intimate partner violence", keywords="eHealth", keywords="pregnancy", keywords="antenatal care, safety behaviors", keywords="tablet intervention", abstract="Background: Intimate partner violence (IPV) is recognized as a global health problem. Women with low education and limited resources are more vulnerable, as are immigrant women. There is a lack of evidence on how health care professionals should communicate about and intervene against IPV during pregnancy. Earlier research has shown that when women manage digital questionnaires, they are more likely to disclose IPV. However, little is known about how women experience eHealth interventions with safety behaviors to prevent IPV. Objective: The aim of this study was to explore pregnant women's attitudes toward and experiences with a tablet intervention to promote safety behaviors in a randomized controlled trial (RCT) in antenatal care. Methods: Individual semistructured interviews were conducted with 10 women who participated in the Safe Pregnancy Study. The Safe Pregnancy Study was a randomized controlled trial (RCT) using a tablet intervention containing IPV questions and a film to promote safety behaviors. Six women from the intervention group and four women from the control group were recruited. The content was available in Norwegian, Somali, and Urdu. Five of the women participating in the interviews spoke Norwegian at home and five spoke another language. The majority of the women who did not speak Norwegian at home perceived themselves as relatively well integrated. The interviews were conducted at different maternal and child health centers (MCHCs) in Norway between March 2020 and June 2020. The analysis was guided by thematic analysis. Results: Women who participated in the tablet intervention appreciated being asked questions about IPV on a tablet. However, it was important to supplement the tablet intervention with face-to-face communication with a midwife. The MCHC was regarded as a suitable place to answer questions and watch a film about safety behaviors. Women suggested making the tablet intervention available in other settings where women meet health care professionals. Some women expressed uncertainty about their anonymity regarding their answers in the questionnaire. We found no real differences between ethnic Norwegian and immigrant women's attitudes toward and experiences with the tablet intervention. Conclusions: Questions about IPV and a film about safety behaviors on a tablet, as a supplement to face-to-face communication, might initiate and facilitate communication about IPV in antenatal care. Uncertainty regarding anonymity has to be addressed when questions about IPV are being asked on a tablet. Trial Registration: ClinicalTrials.gov NCT03397277; https://clinicaltrials.gov/ct2/show/NCT03397277 ", doi="10.2196/28680", url="https://formative.jmir.org/2021/7/e28680", url="http://www.ncbi.nlm.nih.gov/pubmed/34283023" } @Article{info:doi/10.2196/28738, author="Andy, Anietie", title="Studying How Individuals Who Express the Feeling of Loneliness in an Online Loneliness Forum Communicate in a Nonloneliness Forum: Observational Study", journal="JMIR Form Res", year="2021", month="Jul", day="20", volume="5", number="7", pages="e28738", keywords="loneliness", keywords="Reddit", keywords="nonloneliness", keywords="mental health", keywords="eHealth", keywords="forum", keywords="online forum", keywords="communication", keywords="natural language processing", keywords="language", keywords="linguistics", abstract="Background: Loneliness is a public health concern, and increasingly, individuals experiencing loneliness are seeking support on online forums, some of which focus on discussions around loneliness (loneliness forums). Some of these individuals may also seek support around loneliness on online forums not related to loneliness or well-being (nonloneliness forums). Hence, to design and implement appropriate and efficient online loneliness interventions, it is important to understand how individuals who express and seek support around loneliness on online loneliness forums communicate in nonloneliness forums; this could provide further insights into the support needs and concerns of these users. Objective: This study aims to explore how users who express the feeling of loneliness and seek support around loneliness on an online loneliness forum communicate in an online nonloneliness forum. Methods: A total of 2401 users who expressed loneliness in posts published on a loneliness forum on Reddit and had published posts in a nonloneliness forum were identified. Using latent Dirichlet allocation (a natural language processing algorithm); Linguistic Inquiry and Word Count (a psycholinguistic dictionary); and the word score--based language features valence, arousal, and dominance, the language use differences in posts published in the nonloneliness forum by these users compared to a control group of users who did not belong to any loneliness forum on Reddit were determined. Results: It was found that in posts published in the nonloneliness forum, users who expressed loneliness tend to use more words associated with the Linguistic Inquiry and Word Count categories on sadness (Cohen d=0.10) and seeking to socialize (Cohen d=0.114), and use words associated with valence (Cohen d=0.364) and dominance (Cohen d=0.117). In addition, they tend to publish posts related to latent Dirichlet allocation topics such as relationships (Cohen d=0.105) and family and friends and mental health (Cohen d=0.10). Conclusions: There are clear distinctions in language use in nonloneliness forum posts by users who express loneliness compared to a control group of users. These findings can help with the design and implementation of online interventions around loneliness. ", doi="10.2196/28738", url="https://formative.jmir.org/2021/7/e28738", url="http://www.ncbi.nlm.nih.gov/pubmed/34283026" } @Article{info:doi/10.2196/27891, author="Alinia, Parastoo and Sah, Kumar Ramesh and McDonell, Michael and Pendry, Patricia and Parent, Sara and Ghasemzadeh, Hassan and Cleveland, John Michael", title="Associations Between Physiological Signals Captured Using Wearable Sensors and Self-reported Outcomes Among Adults in Alcohol Use Disorder Recovery: Development and Usability Study", journal="JMIR Form Res", year="2021", month="Jul", day="21", volume="5", number="7", pages="e27891", keywords="alcohol relapse prevention", keywords="stress markers", keywords="alcohol consumption", keywords="electrodermal activity", keywords="heart rate variability", keywords="emotion", keywords="mobile phone", abstract="Background: Previous research has highlighted the role of stress in substance misuse and addiction, particularly for relapse risk. Mobile health interventions that incorporate real-time monitoring of physiological markers of stress offer promise for delivering tailored interventions to individuals during high-risk states of heightened stress to prevent alcohol relapse. Before such interventions can be developed, measurements of these processes in ambulatory, real-world settings are needed. Objective: This research is a proof-of-concept study to establish the feasibility of using a wearable sensor device to continuously monitor stress in an ambulatory setting. Toward that end, we first aimed to examine the quality of 2 continuously monitored physiological signals---electrodermal activity (EDA) and heart rate variability (HRV)---and show that the data follow standard quality measures according to the literature. Next, we examined the associations between the statistical features extracted from the EDA and HRV signals and self-reported outcomes. Methods: Participants (N=11; female: n=10) were asked to wear an Empatica E4 wearable sensor for continuous unobtrusive physiological signal collection for up to 14 days. During the same time frame, participants responded to a daily diary study using ecological momentary assessment of self-reported stress, emotions, alcohol-related cravings, pain, and discomfort via a web-based survey, which was conducted 4 times daily. Participants also participated in structured interviews throughout the study to assess daily alcohol use and to validate self-reported and physiological stress markers. In the analysis, we first used existing artifact detection methods and physiological signal processing approaches to assess the quality of the physiological data. Next, we examined the descriptive statistics for self-reported outcomes. Finally, we investigated the associations between the features of physiological signals and self-reported outcomes. Results: We determined that 87.86\% (1,032,265/1,174,898) of the EDA signals were clean. A comparison of the frequency of skin conductance responses per minute with previous research confirmed that the physiological signals collected in the ambulatory setting were successful. The results also indicated that the statistical features of the EDA and HRV measures were significantly correlated with the self-reported outcomes, including the number of stressful events marked on the sensor device, positive and negative emotions, and experienced pain and discomfort. Conclusions: The results demonstrated that the physiological data collected via an Empatica E4 wearable sensor device were consistent with previous literature in terms of the quality of the data and that features of these physiological signals were significantly associated with several self-reported outcomes among a sample of adults diagnosed with alcohol use disorder. These results suggest that ambulatory assessment of stress is feasible and can be used to develop tailored mobile health interventions to enhance sustained recovery from alcohol use disorder. ", doi="10.2196/27891", url="https://formative.jmir.org/2021/7/e27891", url="http://www.ncbi.nlm.nih.gov/pubmed/34287205" } @Article{info:doi/10.2196/27094, author="Primholdt Christensen, Nina and Skou, Emilie Karen and Boe Danbj{\o}rg, Dorthe", title="Health Care Professionals' Experiences With the Use of Video Consultation: Qualitative Study", journal="JMIR Form Res", year="2021", month="Jul", day="21", volume="5", number="7", pages="e27094", keywords="video consultation", keywords="hematology", keywords="outpatient clinic", keywords="telehealth", keywords="doctor's perspective", abstract="Background: The number of remote video consultations between doctors and patients has increased during the last few years and especially during the COVID-19 pandemic. The health care service is faced with rising rates of chronic illness and many patients who are more confident in self-management of their illnesses. In addition, there is an improved long-term outlook for serious conditions, such as cancer, that might require flexibility in everyday life. Objective: This study aimed to investigate how medical doctors in the outpatient clinic use and experience the use of video consultations with hematological patients, with a focus on relational and organizational aspects. Methods: The study was designed as an explorative and qualitative study. Data were collected via participant observations and focus group interviews with medical doctors. Results: The study identified possibilities and barriers in relation to adapting to the alternative way of meeting patients in the clinical setting. One of the main findings in this study is that the medical doctors were afraid that they missed important observations, as they were not able to perform a physical examination, if needed. They also emphasized that handshake and eye contact were important in order to get an overall impression of the patient's situation. It also became clear that the medical doctors used body language a lot more during video consultation compared with consultation in a physical setting. The medical doctors found the contact with the patients via the screen to be good, and the fact that the technology was working well made them feel comfortable with the video consultation. Conclusions: In this study, we found that the medical doctors were able to maintain good contact with the patients despite the screen and were able to assess the patients in a satisfying manner. However, there were still uncertainties among some doctors about the fact that they could not examine the patients physically. New knowledge about how to use gestures and body language during video consultation was obtained. ", doi="10.2196/27094", url="https://formative.jmir.org/2021/7/e27094", url="http://www.ncbi.nlm.nih.gov/pubmed/34287207" } @Article{info:doi/10.2196/22709, author="Woodford, Joanne and Farrand, Paul and Hagstr{\"o}m, Josefin and Hedenmalm, Li and von Essen, Louise", title="Internet-Administered Cognitive Behavioral Therapy for Common Mental Health Difficulties in Parents of Children Treated for Cancer: Intervention Development and Description Study", journal="JMIR Form Res", year="2021", month="Jul", day="22", volume="5", number="7", pages="e22709", keywords="parents", keywords="eMental health", keywords="internet-administered cognitive behavioral therapy", keywords="ICBT", keywords="TIDieR", keywords="CBT self-help", keywords="low-intensity CBT", keywords="mobile phone", abstract="Background: Following the end of a child's treatment for cancer, parents may report psychological distress. However, there is a lack of evidence-based interventions that are tailored to the population, and psychological support needs are commonly unmet. An internet-administered low-intensity cognitive behavioral therapy (LICBT)--based intervention (EJDeR [internetbaserad sj{\"a}lvhj{\"a}lp f{\"o}r f{\"o}r{\"a}ldrar till barn som avslutat en behandling mot cancer]) may provide a solution. Objective: The first objective is to provide an overview of a multimethod approach that was used to inform the development of the EJDeR intervention. The second objective is to provide a detailed description of the EJDeR intervention in accordance with the Template for Intervention Description and Replication (TIDieR) checklist. Methods: EJDeR was developed through a multimethod approach, which included the use of existing evidence, the conceptualization of distress, participatory action research, a cross-sectional survey, and professional and public involvement. Depending on the main presenting difficulty identified during assessment, LICBT behavioral activation or worry management treatment protocols are adopted for the treatment of depression or generalized anxiety disorder when experienced individually or when comorbid. EJDeR is delivered via the Uppsala University Psychosocial Care Programme (U-CARE) portal, a web-based platform that is designed to deliver internet-administered LICBT interventions and includes secure videoconferencing. To guide parents in the use of EJDeR, weekly written messages via the portal are provided by e-therapists comprising final year psychology program students with training in cognitive behavioral therapy. Results: An overview of the development process and a description of EJDeR, which was informed by the TIDieR checklist, are presented. Adaptations that were made in response to public involvement are highlighted. Conclusions: EJDeR represents a novel, guided, internet-administered LICBT intervention for supporting parents of children treated for cancer. Adopting the TIDieR checklist offers the potential to enhance fidelity to the intervention protocol and facilitate later implementation. The intervention is currently being tested in a feasibility study (the ENGAGE study). International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-023708 ", doi="10.2196/22709", url="https://formative.jmir.org/2021/7/e22709", url="http://www.ncbi.nlm.nih.gov/pubmed/34142662" } @Article{info:doi/10.2196/26183, author="Karim, Sana and Hsiung, Kimberly and Symonds, Maria and Radovic, Ana", title="Experience of Peer Bloggers Using a Social Media Website for Adolescents With Depression or Anxiety: Proof-of-Concept Study", journal="JMIR Form Res", year="2021", month="Jul", day="22", volume="5", number="7", pages="e26183", keywords="adolescent", keywords="social media", keywords="blogging", keywords="depression", keywords="anxiety", abstract="Background: Supporting Our Valued Adolescents (SOVA) is a moderated and anonymous social media website intervention. SOVA ambassadors are adolescents and young adults (AYA) asked to write monthly blog posts and comments on others' posts on topics surrounding mental health. Objective: This study aims to understand the feasibility and acceptability of peer blogging for a moderated mental health intervention website and explore whether bloggers---AYA who self-report symptoms of depression and anxiety---experience potential benefits. Methods: AYA aged 14 to 26 years with a self-reported history of depression or anxiety were recruited to the SOVA Peer Ambassador Program. Participants were asked to write one blog post a month and comment at least four times a month on other blog posts, for which they were compensated for up to US \$15 monthly. Outcome variables measured at baseline and 3 months after intervention included website usability and feasibility, depressive symptoms, anxiety symptoms, mental health treatment history, cybercoping, personal blogging style, self-esteem, loneliness, mental health stigma, social support, and positive youth development characteristics. Open-ended questions were asked about their blogging acceptability and usability. Results: Of 66 AYA showing interest and completing onboarding, 71\% (47/66) wrote at least one blog post, with an average of 3 posts per person. A sample of 51\% (34/66) of participants completed a 3-month survey for the full analysis. Almost all 34 participants were satisfied with the experience of blogging (32/34, 94\%) and rated the website usability as good (80.1, SD 14.9). At 3 months, self-esteem scores increased by 2.1, with a small-medium effect size (P=.01; Cohen d=0.45), and youth competence and confidence increased by 0.7 (P=.002) and 1.3 (P=.002), with medium effect sizes (Cohen d=0.62 and 0.60), respectively. Conclusions: A blogging intervention for AYA with a history of depression or anxiety was feasible with regular and active engagement and shows evidence in a one-sample design for positive changes in strength-based assets---self-esteem, competence, and confidence---which map onto resilience. ", doi="10.2196/26183", url="https://formative.jmir.org/2021/7/e26183", url="http://www.ncbi.nlm.nih.gov/pubmed/34292161" } @Article{info:doi/10.2196/17910, author="Simonsson, Olivia and Engberg, Hedvig and Bjureberg, Johan and Lj{\'o}tsson, Brj{\'a}nn and Stensils, Julia and Sahlin, Hanna and Hellner, Clara", title="Experiences of an Online Treatment for Adolescents With Nonsuicidal Self-injury and Their Caregivers: Qualitative Study", journal="JMIR Form Res", year="2021", month="Jul", day="23", volume="5", number="7", pages="e17910", keywords="nonsuicidal self-injury", keywords="self-injurious behavior", keywords="online treatment", keywords="internet", keywords="digital health", keywords="emotion regulation", keywords="emotion regulation individual therapy for adolescents", keywords="adolescent", keywords="qualitative", keywords="experience", abstract="Background: Nonsuicidal self-injury (NSSI) is common in adolescence and is associated with several adverse outcomes. Despite this, few established treatment options exist. Online treatment seems promising for several conditions; however, knowledge on NSSI is scarce. It is important to explore how online treatment for NSSI is experienced to improve such interventions and learn more about factors that are important in the treatment of adolescents with NSSI. Objective: This study aims to explore the experiences of a novel online treatment for adolescents with NSSI and their caregivers. Methods: A qualitative study using thematic analysis was conducted through semistructured interviews with 9 adolescents and 11 caregivers at treatment termination or at the 6-month follow-up of the online emotion regulation individual therapy for adolescents. Results: A total of 3 overarching themes were identified. The theme support can come in different shapes showed how support could be attained through both interaction with the therapist as well as through the format itself (such as through the fictional characters in the material and the mobile app). Caregivers found it helpful to have their own online course, and adolescents accepted their involvement. The theme self-responsibility can be empowering as well as distressing showed that self-responsibility was highly appreciated (such as deciding when and how to engage in treatment) but also challenging; it caused occasional distress for some. The theme acquiring new skills and treatment effects showed the advantages and challenges of learning several different emotion regulation skills and that decreased emotion regulation difficulties were important treatment outcomes for adolescents. In addition, several different skills seemed to facilitate emotion regulation, and having access to such skills could hinder NSSI. Conclusions: Online emotion regulation individual therapy for adolescents seems to offer an accepted way to deliver family interventions for this target group; facilitate skills training with several means of support, including support from both the mobile app and the therapist; contribute to decreasing emotion regulation difficulties and teaching skills that could hinder NSSI; and cause (in some individuals) distress because of the self-responsibility that is inherent to online formats, which needs to be addressed. ", doi="10.2196/17910", url="https://formative.jmir.org/2021/7/e17910", url="http://www.ncbi.nlm.nih.gov/pubmed/34297001" } @Article{info:doi/10.2196/25926, author="Mhende, Josephine and Bell, A. Sharrill and Cottrell-Daniels, Cherell and Luong, Jackie and Streiff, Micah and Dannenfelser, Mark and Hayat, J. Matthew and Spears, Adams Claire", title="Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial", journal="JMIR Form Res", year="2021", month="Jul", day="23", volume="5", number="7", pages="e25926", keywords="acceptability", keywords="addiction", keywords="African American", keywords="cessation", keywords="COVID-19", keywords="feasibility", keywords="income", keywords="low socioeconomic status", keywords="mHealth", keywords="mindfulness", keywords="minority", keywords="smoking", keywords="SMS", keywords="text messaging", keywords="treatment", abstract="Background: Smoking is the leading cause of premature death, and low-income adults experience disproportionate burden from tobacco. Mindfulness interventions show promise for improving smoking cessation. A text messaging program ``iQuit Mindfully'' was developed to deliver just-in-time support for quitting smoking among low-income adults. A pilot study of iQuit Mindfully was conducted in spring 2020, during the COVID-19 pandemic, among low-income and predominantly African American smokers. Objective: This pilot study examined the acceptability and feasibility of delivering Mindfulness-Based Addiction Treatment via mHealth during the COVID-19 pandemic. Methods: Participants were adult cigarette smokers (n=23), of whom 8 (34.8\%) were female, 19 (82.6\%) were African American, and 18 (78.3\%) had an annual income of