%0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e18586 %T A Web-Delivered Acceptance and Commitment Therapy Intervention With Email Reminders to Enhance Subjective Well-Being and Encourage Engagement With Lifestyle Behavior Change in Health Care Staff: Randomized Cluster Feasibility Stud %A Brown,Menna %A Hooper,Nic %A James,Phillip %A Scott,Darren %A Bodger,Owen %A John,Ann %+ Swansea University Medical School, Swansea University, Singleton Park, Data Science Building, Floor 3, Swansea, SA2 8PP, United Kingdom, 44 1792 606312, menna.brown@swansea.ac.uk %K well-being %K mental health %K behavior change %K acceptance and commitment therapy %K web-delivered intervention %K gamification %K adherence and engagement %K internet-based intervention %D 2020 %7 7.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor mental health and emotional well-being can negatively impact ability to engage in healthy lifestyle behavior change. Health care staff have higher rates of sickness and absence than other public sector staff, which has implications at both individual and societal levels. Individual efforts to self-manage health and well-being which add to the UK mental health prevention agenda need to be supported. Objective: The objective of this study was to establish the feasibility and acceptability of the inclusion of a self-guided, automated, web-based acceptance and commitment therapy intervention in an existing health promotion program, to improve subjective well-being and encourage engagement with lifestyle behavior change. Methods: For this 12-week, 4-armed, randomized controlled cluster feasibility study, we recruited participants offline and randomly allocated them to 1 of 3 intervention arms or control (no well-being intervention) using an automated web-based allocation procedure. Eligibility criteria were current health care staff in 1 Welsh health board, age≥18 years, ability to read English, and ability to provide consent. The primary researcher was blinded to cluster allocation. Feasibility outcomes were randomization procedure, acceptance of intervention, and adherence to and engagement with the wider program. We evaluated health and well-being data via self-assessment at 2 time points, registration and postintervention, using the 14-item Warwick-Edinburgh Mental Well-Being Scale, the 4-item Patient Health Questionnaire, and the 7-item Acceptance and Action Questionnaire—Revised. Results: Of 124 participants who provided consent and were randomly allocated, 103 completed full registration and engaged with the program. Most participants (76/103) enrolled in at least one health behavior change module, and 43% (41/96) of those randomly allocated to an intervention arm enrolled in the well-being module. Adherence and engagement was low (7/103, 6.8%), but qualitative feedback was positive. Conclusions: The procedure and randomization process proved feasible, and the addition of the well-being module proved acceptable to health care staff. However, participant engagement was limited, and no one completed the full 12-week program. User feedback should be used to develop the intervention to address poor engagement. Effectiveness should then be evaluated in a full-scale randomized controlled trial, which would be feasible with additional recruitment. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 50074817; http://www.isrctn.com/ISRCTN50074817 %M 32763887 %R 10.2196/18586 %U https://formative.jmir.org/2020/8/e18586 %U https://doi.org/10.2196/18586 %U http://www.ncbi.nlm.nih.gov/pubmed/32763887 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e18347 %T Perceptions and Attitudes Toward a Mobile Phone App for Mental Health for College Students: Qualitative Focus Group Study %A Holtz,Bree E %A McCarroll,Alexis M %A Mitchell,Katharine M %+ Michigan State University, 404 Wilson Road, Room 309, East Lansing, MI, United States, 1 5178844537, bholtz@msu.edu %K mental health %K mobile phone %K mHealth %D 2020 %7 7.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Many college students who have mental health issues do not receive professional care for various reasons. Students who do not receive help often have both short- and long-term adverse health outcomes. Mobile apps for mental health services such as MySSP, a service provided to college students through their university, may help eliminate barriers to seeking mental health care and result in more positive outcomes for college students. Objective: This qualitative study aims to better understand college students’ perceptions and attitudes toward the adoption and use of a mobile phone app for mental health, MySSP, using the technology acceptance model (TAM). Methods: A series of nine focus groups were conducted with college students (N=30) between February and May 2019 at a large, public Midwestern university. The moderator’s guide was based on the TAM, and focus group sessions primarily focused on the use and knowledge of apps for mental health, specifically, MySSP. The focus group transcriptions were hand-coded to develop a set of themes that encompassed students’ perceptions and attitudes toward MySSP. Results: The analysis of the focus groups suggested the following themes: (1) existing awareness of the app, (2) perceived usefulness, (3) perceived ease of use, (4) attitudes toward apps for mental health and MySSP, and (5) social influence. Conclusions: The results of this study provide deeper insights into the perceptions of a mobile app for mental health among college students. Future research should explore the specific contexts in which an app for mental health will be most effective for college students. %M 32667892 %R 10.2196/18347 %U https://formative.jmir.org/2020/8/e18347 %U https://doi.org/10.2196/18347 %U http://www.ncbi.nlm.nih.gov/pubmed/32667892 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e18123 %T Clinician Perspectives and Design Implications in Using Patient-Generated Health Data to Improve Mental Health Practices: Mixed Methods Study %A Wu,Danny T Y %A Xin,Chen %A Bindhu,Shwetha %A Xu,Catherine %A Sachdeva,Jyoti %A Brown,Jennifer L %A Jung,Heekyoung %+ Department of Biomedical Informatics, College of Medicine, University of Cincinnati, 231 Albert Sabin Way, ML0840, Cincinnati, OH, 45229, United States, 1 5135586464, wutz@ucmail.uc.edu %K patient-generated health data %K mental health %K workflow %K mobile application %K interview %D 2020 %7 7.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient-generated health data (PGHD) have been largely collected through mobile health (mHealth) apps and wearable devices. PGHD can be especially helpful in mental health, as patients’ illness history and symptom narratives are vital to developing diagnoses and treatment plans. However, the extent to which clinicians use mental health–related PGHD is unknown. Objective: A mixed methods study was conducted to understand clinicians’ perspectives on PGHD and current mental health apps. This approach uses information gathered from semistructured interviews, workflow analysis, and user-written mental health app reviews to answer the following research questions: (1) What is the current workflow of mental health practice and how are PGHD integrated into this workflow, (2) what are clinicians’ perspectives on PGHD and how do they choose mobile apps for their patients, (3) and what are the features of current mobile apps in terms of interpreting and sharing PGHD? Methods: The study consists of semistructured interviews with 12 psychiatrists and clinical psychologists from a large academic hospital. These interviews were thematically and qualitatively analyzed for common themes and workflow elements. User-posted reviews of 56 sleep and mood tracking apps were analyzed to understand app features in comparison with the information gathered from interviews. Results: The results showed that PGHD have been part of the workflow, but its integration and use are not optimized. Mental health clinicians supported the use of PGHD but had concerns regarding data reliability and accuracy. They also identified challenges in selecting suitable apps for their patients. From the app review, it was discovered that mHealth apps had limited features to support personalization and collaborative care as well as data interpretation and sharing. Conclusions: This study investigates clinicians’ perspectives on PGHD use and explored existing app features using the app review data in the mental health setting. A total of 3 design guidelines were generated: (1) improve data interpretation and sharing mechanisms, (2) consider clinical workflow and electronic health record integration, and (3) support personalized and collaborative care. More research is needed to demonstrate the best practices of PGHD use and to evaluate their effectiveness in improving patient outcomes. %M 32763884 %R 10.2196/18123 %U https://formative.jmir.org/2020/8/e18123 %U https://doi.org/10.2196/18123 %U http://www.ncbi.nlm.nih.gov/pubmed/32763884 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e15669 %T Needs and Requirements in the Designing of Mobile Interventions for Patients With Peripheral Arterial Disease: Questionnaire Study %A Lortz,Julia %A Simanovski,Jan %A Kuether,Tabea %A Kreitschmann-Andermahr,Ilonka %A Ullrich,Greta %A Steinmetz,Martin %A Rammos,Christos %A Jánosi,Rolf Alexander %A Moebus,Susanne %A Rassaf,Tienush %A Paldán,Katrin %+ Department of Cardiology and Vascular Medicine, West-German Heart and Vascular Center Essen, University of Duisburg-Essen, Hufelandstraße 55, Essen, 45147, Germany, 49 201 723 4801, julia.lortz@uk-essen.de %K peripheral arterial disease %K mHealth %K digital intervention %K supervised exercise therapy %K smartphone usage %D 2020 %7 4.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The development of mobile interventions for noncommunicable diseases has increased in recent years. However, there is a dearth of apps for patients with peripheral arterial disease (PAD), who frequently have an impaired ability to walk. Objective: Using a patient-centered approach for the development of mobile interventions, we aim to describe the needs and requirements of patients with PAD regarding the overall care situation and the use of mobile interventions to perform supervised exercise therapy (SET). Methods: A questionnaire survey was conducted in addition to a clinical examination at the vascular outpatient clinic of the West-German Heart and Vascular Center of the University Clinic Essen in Germany. Patients with diagnosed PAD were asked to answer questions on sociodemographic characteristics, PAD-related need for support, satisfaction with their health care situation, smartphone and app use, and requirements for the design of mobile interventions to support SET. Results: Overall, a need for better support of patients with diagnosed PAD was identified. In total, 59.2% (n=180) expressed their desire for more support for their disease. Patients (n=304) had a mean age of 67 years and half of them (n=157, 51.6%) were smartphone users. We noted an interest in smartphone-supported SET, even for people who did not currently use a smartphone. “Information,” “feedback,” “choosing goals,” and “interaction with physicians and therapists” were rated the most relevant components of a potential app. Conclusions: A need for the support of patients with PAD was determined. This was particularly evident with regard to disease literacy and the performance of SET. Based on a detailed description of patient characteristics, proposals for the design of mobile interventions adapted to the needs and requirements of patients can be derived. %M 32663154 %R 10.2196/15669 %U https://formative.jmir.org/2020/8/e15669 %U https://doi.org/10.2196/15669 %U http://www.ncbi.nlm.nih.gov/pubmed/32663154 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17481 %T A Mobile Health Approach for Improving Outcomes in Suicide Prevention (SafePlan) %A O'Grady,Conor %A Melia,Ruth %A Bogue,John %A O'Sullivan,Mary %A Young,Karen %A Duggan,Jim %+ School of Computer Science, National University of Ireland Galway, University Road, Galway, H91 TK33, Ireland, 353 91493336, james.duggan@nuigalway.ie %K mobile apps %K suicide %K mHealth %D 2020 %7 30.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Suicide is a prominent cause of death worldwide, particularly among young people. It was the second leading cause of death among those aged 15-29 years globally in 2016. Treatment for patients with suicidal thoughts or behaviors often includes face-to-face psychological therapy with a mental health professional. These forms of interventions may involve maintaining and updating paper-based reports or worksheets in between sessions. Mobile technology can offer a way to support the implementation of evidence-based psychological techniques and the acquisition of protective coping skills. Objective: This study aims to develop a mobile app to facilitate service users’ access to mental health support and safety planning. This process involved eliciting expert input from clinicians who are actively engaged in the provision of mental health care. Methods: A survey was distributed to targeted health care professionals to determine what features should be prioritized in a new mobile app relating to suicide prevention. On the basis of the survey results, a clinical design group, comprising 6 members with experience in fields such as mobile health (mHealth), clinical psychology, and suicide prevention, was established. This group was supplemented with further input from additional clinicians who provided feedback over three focus group sessions. The sessions were centered on refining existing app components and evaluating new feature requests. This process was iterated through regular feedback until agreement was reached on the overall app design and functionality. Results: A fully functional mobile app, known as the SafePlan app, was developed and tested with the input of clinicians through an iterative design process. The app’s core function is to provide an interactive safety plan to support users with suicidal thoughts or behaviors as an adjunct to face-to-face therapy. A diary component that facilitates the generalization of skills learned through dialectical behavior therapy was also implemented. Usability testing was carried out on the final prototype by students from a local secondary school, who are representative of the target user population in both age and technology experience. The students were asked to complete a system usability survey (SUS) at the end of this session. The mean overall SUS rating was 71.85 (SD 1.38). Conclusions: The participatory process involving key stakeholders (clinicians, psychologists, and information technology specialists) has resulted in the creation of an mHealth intervention technology that has the potential to increase accessibility to this type of mental health service for the target population. The app has gone through the initial testing phase, and the relevant recommendations have been implemented, and it is now ready for trialing with both clinicians and their patients. %M 32729845 %R 10.2196/17481 %U http://www.jmir.org/2020/7/e17481/ %U https://doi.org/10.2196/17481 %U http://www.ncbi.nlm.nih.gov/pubmed/32729845 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18157 %T Designing a Personalized Digital Patient Support Program for Patients Treated With Growth Hormone: Key Design Considerations %A Malik,Sumaira %A Moloney,Clare %A Koledova,Ekaterina %A Reston,Jonathan %A Weinman,John %+ Atlantis Healthcare, Building 5 Chiswick Park, Chiswick High Road, London, W4 5YA, United Kingdom, 44 2087474360, sumaira.malik@atlantishealthcare.com %K growth hormone %K behavior change wheel %K somatropin %K adherence %D 2020 %7 29.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Recombinant human growth hormone treatment can optimize growth potential; however, optimal outcomes are not always achieved for several reasons, including poor adherence. The overall objective of this project was to design a patient support program to maximize the chances of treatment success for people being treated with somatropin injection. An approach known as the behavior change wheel was used to enhance the development of the patient support program. The behavior change wheel provided a comprehensive framework to support the design of interventions. Objective: The aim of this paper was to describe how the steps of the behavior change wheel were applied to the development of a patient support program for individuals with growth hormone deficiency undergoing treatment with somatropin. Methods: We followed a series of steps that align to tenets of the behavior change wheel, namely, a narrative literature review to identify which behaviors needed to change and the potential drivers of and barriers to the behaviors, the selection of an intervention strategy and discrete behavior change techniques, and, finally, intervention specification. Results: A recent systematic review identified a range of potentially modifiable factors found to have an influence on patient adherence to growth hormone treatment. Insights from the systematic review were used to guide the development of a patient support program. The final design of the patient support program consisted of four elements: (1) a personalization questionnaire to tailor support for each individual, (2) tailored reminder and support SMS text messages, (3) nurse-led phone calls, and (4) Easypod connect, an automated electronic autoinjector drug-delivery device with a transmitter and connection platform for Saizen (somatropin) that allows automatic recording, storage, and transmission of drug-usage data, thus providing insight into suboptimal adherence. Conclusions: The patient support program that was designed is currently being piloted with patients to assess engagement with the program and determine its impact on patient outcomes. Results from the pilot will be used to further refine the program to ensure it meets user needs. %M 32723712 %R 10.2196/18157 %U http://www.jmir.org/2020/7/e18157/ %U https://doi.org/10.2196/18157 %U http://www.ncbi.nlm.nih.gov/pubmed/32723712 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16687 %T Building a Successful Massive Open Online Course About Multiple Sclerosis: A Process Description %A Claflin,Suzi B %A Gates,Rachael %A Maher,Maree %A Taylor,Bruce V %+ Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, 7000, Australia, 61 0362267728, suzi.claflin@utas.edu.au %K multiple sclerosis %K health education %D 2020 %7 29.7.2020 %9 Viewpoint %J J Med Internet Res %G English %X Background: Over the course of a year, we developed and tested a 6-week massive open online course (MOOC) on multiple sclerosis (MS) in consultation with the MS community. The course targeted the MS community and interested laypeople and was titled Understanding MS. The primary purpose of the course was to improve MS knowledge, health literacy, and resilience among participants. The final version of the MOOC made available for open enrollment was ranked first among all MOOCs released in 2019 (n>2400) based on participant reviews. Objective: The aim of this study was to present a detailed description and assessment of the development process of the Understanding MS MOOC. Methods: The development process included a course development focus group; the creation of more than 50 content videos and related text, quizzes, activities, and discussion prompts; the creation of original images and animations; a pilot study; and collaborations with people living with MS, MS nurses, allied health care practitioners, and neurologists and researchers from 4 universities. Results: Overall, the process was efficient and effective. With a few small changes, we recommend this approach to those seeking to develop a similar course. This process led to the development of a highly reviewed MOOC with excellent user satisfaction. Conclusions: We identified 5 key lessons from this process: (1) community support is essential, (2) stakeholder involvement improves content quality, (3) plan for research from the beginning, (4) coordination between the academic lead and project manager team ensures a consistent voice, and (5) a network of collaborators is a key resource. %M 32723726 %R 10.2196/16687 %U https://www.jmir.org/2020/7/e16687 %U https://doi.org/10.2196/16687 %U http://www.ncbi.nlm.nih.gov/pubmed/32723726 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18779 %T Development and Usability Evaluation of a Facebook-Based Intervention Program for Childhood Cancer Patients: Mixed Methods Study %A Park,Bu Kyung %A Kim,Ji Yoon %A Rogers,Valerie E %+ College of Nursing, Research Institute of Nursing Science, Kyungpook National University, 680 Gukchaegosang-ro, Jung-gu, Daegu, 41944, Republic of Korea, 82 53 420 4929, bukpark@knu.ac.kr %K pediatric cancer patients %K childhood cancer %K social network site %K Facebook %K usability %D 2020 %7 28.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Childhood cancers previously considered to be incurable now have 5-year survival rates up to 84%. Nevertheless, these patients remain at risk of morbidity and mortality from therapy-related complications. Thus, patient education and self-management strategies for promoting a healthy lifestyle are of tantamount importance for improving short- and long-term health outcomes. A Facebook-based “Healthy Teens for Soaam” (a Korean term for childhood cancers) program was developed to help improve knowledge and self-management practices of teens with cancer related to their disease and treatment. Objective: The two-fold purpose of this usability study was (1) to describe the process of developing an 8-week Facebook-based intervention program for teens with cancer, and (2) to evaluate its usability to refine the program. Methods: Multiple phases and methods were employed to develop and evaluate the usability of the program. Study phases included: (1) needs assessment through focus group interviews and qualitative content analysis, (2) development of module content, (3) expert review and feedback on module content, (4) Facebook-based program development, (5) usability evaluation by heuristic evaluation, (6) usability evaluation by targeted end-user testing, and (7) modification and final version of the program. Usability of the final version was confirmed through feedback loops of these phases. Results: Based on 6 focus group discussion sessions, it was determined that teens with cancer were interested in seeing stories of successful childhood cancer cases and self-management after discharge, and preferred multimedia content over text. Therefore, each Facebook module was redesigned to include multimedia materials such as relevant video clips tailored for teens. Usability assessed by heuristic evaluation and user testing revealed several critical usability issues, which were then revised. Potential end users tested the final program and perceived it to be usable and useful for teens with cancer. Conclusions: To our knowledge, “Healthy Teens for Soaam” is the first Facebook-based intervention program for teens with cancer. We actively worked with current childhood cancer patients and survivors to develop and improve this program, achieved good usability, and met the expressed needs and preferences of target end users. This 8-week Facebook-based educational program for teens with cancer, developed as the first step of an upcoming intervention study, will be useful for improving knowledge and self-management strategies of teens. %M 32720897 %R 10.2196/18779 %U http://www.jmir.org/2020/7/e18779/ %U https://doi.org/10.2196/18779 %U http://www.ncbi.nlm.nih.gov/pubmed/32720897 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e19485 %T A Web-Based Intervention to Prevent Multiple Chronic Disease Risk Factors Among Adolescents: Co-Design and User Testing of the Health4Life School-Based Program %A Champion,Katrina Elizabeth %A Gardner,Lauren Anne %A McGowan,Cyanna %A Chapman,Cath %A Thornton,Louise %A Parmenter,Belinda %A McBride,Nyanda %A Lubans,David R %A McCann,Karrah %A Spring,Bonnie %A Teesson,Maree %A , %A Newton,Nicola Clare %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, The Matilda Centre, Level 6, Jane Foss Russell Building (G02), University of Sydney, NSW, Sydney, 2006, Australia, 61 286279006, katrina.champion@sydney.edu.au %K primary prevention %K schools %K eHealth %K chronic disease %K mobile phone %K health promotion %D 2020 %7 28.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic diseases are the leading cause of death worldwide. Addressing key lifestyle risk factors during adolescence is critical for improving physical and mental health outcomes and reducing chronic disease risk. Schools are ideal intervention settings, and electronic health (eHealth) interventions afford several advantages, including increased student engagement, scalability, and sustainability. Although lifestyle risk behaviors tend to co-occur, few school-based eHealth interventions have targeted multiple behaviors concurrently. Objective: This study aims to summarize the co-design and user testing of the Health4Life school-based program, a web-based cartoon intervention developed to concurrently prevent 6 key lifestyle risk factors for chronic disease among secondary school students: alcohol use, smoking, poor diet, physical inactivity, sedentary recreational screen time, and poor sleep (the Big 6). Methods: The development of the Health4Life program was conducted over 18 months in collaboration with students, teachers, and researchers with expertise relevant to the Big 6. The iterative process involved (1) scoping of evidence and systematic literature review; (2) consultation with adolescents (N=815) via a cross-sectional web-based survey to identify knowledge gaps, attitudes, barriers, and facilitators in relation to the Big 6; (3) content and web development; and (4) user testing of the web-based program with students (n=41) and teachers (n=8) to evaluate its acceptability, relevance, and appeal to the target audience. Results: The co-design process resulted in a six-module, evidence-informed program that uses interactive cartoon storylines and web-based delivery to engage students. Student and teacher feedback collected during user testing was positive in terms of acceptability and relevance. Commonly identified areas for improvement concerned the length of modules, age appropriateness of language and alcohol storyline, the need for character backstories and links to syllabus information, and feasibility of implementation. Modifications were made to address these issues. Conclusions: The Health4Life school-based program is the first universal, web-based program to concurrently address 6 important chronic disease risk factors among secondary school students. By adopting a multiple health behavior change approach, it has the potential to efficiently modify the Big 6 risk factors within one program and to equip young people with the skills and knowledge needed to achieve and maintain good physical and mental health throughout adolescence and into adulthood. %M 32720898 %R 10.2196/19485 %U http://formative.jmir.org/2020/7/e19485/ %U https://doi.org/10.2196/19485 %U http://www.ncbi.nlm.nih.gov/pubmed/32720898 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e17373 %T A Companion App to Support Rheumatology Patients Treated with Certolizumab Pegol: Results From a Usability Study %A Domańska,Barbara %A Vansant,Stijn %A Mountian,Irina %+ UCB Pharma, 208 Bath Road, Slough, United Kingdom, 44 1615 197676, barbara.domanska@UCB.com %K rheumatology %K internet %K digital health %K mobile health %K mHealth %K smartphone %K mobile phone %K validation human factors study %D 2020 %7 27.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Certolizumab pegol (CZP) is an anti-tumor necrosis factor drug approved for the treatment of multiple moderate to severe chronic inflammatory diseases. In the European Union, CZP is approved for administration by subcutaneous self-injection using a prefilled syringe, prefilled pen, or reusable electromechanical auto-injector (electronic device). CimplyMe is a companion app for use alongside CZP self-injection devices, designed to support CZP-treated patients self-managing their treatment and disease. Objective: This study aimed to validate the usability of the companion app by demonstrating that tasks required for use can be performed successfully by intended end users. Methods: We recruited 15 patients with moderate to severe rheumatoid arthritis, currently prescribed biologic treatment, and using apps on a smart phone. Patients were assessed on their ability to use the companion app in a setting designed to simulate a location where patients regularly administer biologic treatment. To assess the usability of the key features of the app, 8 critical and 3 noncritical tasks were designed. Patients’ success on each task was recorded through observations or knowledge-based questions. Successes with difficulty and use errors were also recorded. If a patient made a use error at the first attempt, a second attempt was allowed. Second-attempt use errors were recorded as a task failure. Results: A total of 207 first attempts at the 14 components of the 8 critical tasks were evaluated (3 patients failed to complete one component); 178 (86.0%) critical tasks were successfully completed at the first attempt. The remaining first attempts comprised 16 (7.7%) successes with difficulty and 13 (6.3%) use errors, which had to be repeated. One critical task was not re-attempted by one patient due to time constraints; however, there were no use errors in the 12 completed second attempts. A total of 107 first attempts at the 3 noncritical tasks were made, all of which (107/107, 100.0%) were completed without use errors. Conclusions: In simulated testing, patients were able to successfully use the companion app without formal training. This study suggests the companion app is easy to use and could help patients prescribed CZP better manage their treatment and disease. %M 32716310 %R 10.2196/17373 %U http://formative.jmir.org/2020/7/e17373/ %U https://doi.org/10.2196/17373 %U http://www.ncbi.nlm.nih.gov/pubmed/32716310 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e17220 %T Utility and Perceived Value of a Provincial Digital Diagnostic Imaging Repository: Multimethod Study %A Wickerson,Lisa %A Fujioka,Jamie K %A Kishimoto,Vanessa %A Jamieson,Trevor %A Fine,Ben %A Bhatia,R Sacha %A Desveaux,Laura %+ Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 4163236400 ext 4302, laura.desveaux@wchospital.ca %K diagnostic imaging %K eHealth %K health care delivery %D 2020 %7 27.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Timely and comprehensive diagnostic image sharing across institutional and regional boundaries can produce multiple benefits while supporting integrated models of care. In Ontario, Canada, the Diagnostic Imaging Common Service (DICS) was created as a centralized imaging repository to enable the sharing and viewing of diagnostic images and associated reports across hospital-based and community-based clinicians throughout the province. Objective: The aims of this study were as follows: (1) to explore real-world utilization and perceived clinical value of the DICS following the provision of system-wide access and (2) to identify strategies to optimize the technology platform functionality and encourage adoption. Methods: This multimethod study included semistructured interviews with physicians and administrative stakeholders and descriptive analysis of the current DICS usage data. Results: In this study, 41 participants were interviewed, that is, 34 physicians and 7 administrative stakeholders. The following 4 key themes emerged: (1) utilization of the DICS depended on the awareness of the technology and the preferred channels for accessing images, which varied widely, (2) clinical responsibilities and available institutional resources were the drivers of utilization (or lack thereof), (3) centralized image repositories were perceived to offer value at the patient, clinician, and health care system levels, and (4) the enabling factors to realize value included aspects of technology infrastructure (ie, available functionality) alongside policy supports. High-volume DICS usage was not evenly distributed throughout the province. Conclusions: Suboptimal adoption of the DICS was driven by poor awareness and variations in the clinical workflow. Alignment with physician workflow, policy supports, and investment in key technological features and infrastructure would improve functionality and data comprehensiveness, thereby optimizing health system performance, patient and provider experience, population health, and health care costs. %M 32459644 %R 10.2196/17220 %U https://formative.jmir.org/2020/7/e17220 %U https://doi.org/10.2196/17220 %U http://www.ncbi.nlm.nih.gov/pubmed/32459644 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18437 %T A Community-Engaged Approach to Creating a Mobile HIV Prevention App for Black Women: Focus Group Study to Determine Preferences via Prototype Demos %A Chandler,Rasheeta %A Hernandez,Natalie %A Guillaume,Dominique %A Grandoit,Shanaika %A Branch-Ellis,Desiré %A Lightfoot,Marguerita %+ Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, 30322, United States, 1 404 727 8164, r.d.chandler@emory.edu %K mHealth app %K mobile technology %K Black women %K HIV prevention %K reproductive health %K women’s health %D 2020 %7 24.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Black women are an important but relatively overlooked at-risk group in HIV prevention efforts. Although there is an aggregate decline of HIV diagnoses among women in the United States, there are persistent disparate rates of new HIV infections among Black women compared to any other cisgender female subgroup. Strategies to end the HIV epidemic—as outlined in the Ending the HIV Epidemic initiative—for all communities must consider HIV prevention messaging and message delivery mediums that are created with community input. Although mobile health (mHealth) is a popular platform for delivering HIV interventions, there are currently no mobile apps that consider cisgender Black women with the goal of promoting a comprehensive women’s reproductive health and HIV prevention lifestyle. Previous research recommends inclusion of the target population from project inception and iteratively throughout development, to promote use of the intervention. Objective: The purpose of this study is to understand cisgender Black women’s preferences for functionality, format, and design of a mobile HIV prevention app and to examine their willingness to use an app for HIV prevention. Methods: We conducted a series of four focus groups with 23 Black cisgender women. Focus groups included discussion and demonstration elements to address cisgender women’s general preference for apps, HIV prevention content that would be useful in an app, and preferred app features that would promote use of an HIV-centric app. During focus group discussions, participants were shown narrated, custom wireframes of HIV prevention app prototypes to demonstrate potential app function. Results: Findings indicated the presence of eight subthemes within the coding structure of three overall themes: (1) health content within the mobile app, (2) mobile app functionality, format, and design, and (3) other suggested features. Specifically, participants detailed preferred educational content, content distribution, app aesthetics, privacy considerations, and marketing of the app. Conclusions: Findings suggest that Black cisgender women preferred an app that integrated HIV prevention and optimal sexual health promotion. Participants provided a range of preferences for content integration and facilitators of app engagement with an HIV prevention app. Preferences centered on gender and cultural congruency of information and content, evidenced by visuals, language, and resources. Black cisgender women are viable consumers for a mobile app–based HIV prevention intervention. %M 32706723 %R 10.2196/18437 %U http://mhealth.jmir.org/2020/7/e18437/ %U https://doi.org/10.2196/18437 %U http://www.ncbi.nlm.nih.gov/pubmed/32706723 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e18049 %T MyStrengths, a Strengths-Focused Mobile Health Tool: Participatory Design and Development %A Jessen,Stian %A Mirkovic,Jelena %A Nes,Lise Solberg %+ Department of Digital Health Research, Division of Medicine, Oslo University Hospital, Trondhjemsveien 235, Oslo, 0586, Norway, 47 98049759, stian.jessen@rr-research.no %K mHealth %K participatory design %K personal strengths %K gameful design %K gamification %K iterative development %K positive approach %K co-design %K user engagement %K mobile phone %K chronic care %K self-management %D 2020 %7 24.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: People living with chronic illnesses are an increasingly large group. Research indicates that care and self-management should not only focus on the illness and problem-oriented aspects of these individuals’ lives but also support them in recognizing and leveraging their personal strengths in daily life. Objective: This paper presents the design and developmental process of MyStrengths, a mobile health (mHealth) app designed to help its users (people with chronic conditions) both find and make use of their personal strengths in their daily lives. Through 4 consecutive phases, this paper presents participant- and researcher-driven activities, discussions regarding design, and development of both the MyStrengths app and its content. Methods: During the 4 phases, we used a range of methods and activities, including (1) an idea-generating workshop aimed at creating ideas for strengths-supporting features with different stakeholders, including patients, caregivers, relatives, and designers (N=35); (2) research seminars with an international group of experts (N=6), in which the concept, theoretical background, and design ideas for the app were discussed; (3) a series of co-design workshops with people in the user group (N=22) aiming to create ideas for how to, in an engaging manner, design the app; and (4) in 4 developmental iterations, the app was evaluated by people in the user group (N=13). Content and strengths exercises were worked on and honed by the research team, the expert groups, and our internal editorial team during the entire developmental process. Results: The first phase found a wide range of stakeholder requirements to, and ideas for, strengths-focused mHealth apps. From reviewing literature during the second phase, we found a dearth of research on personal strengths with respect to people living with chronic illnesses. Activities during the third phase creatively provided numerous ideas and suggestions for engaging and gameful ways to develop and design the MyStrengths app. The final phase saw the output from all the earlier phases come together. Through multiple increasingly complete iterations of user evaluations testing and developing, the final prototype of the MyStrengths app was created. Conclusions: Although research supports the use of strengths-focused mHealth tools to support people living with chronic illnesses, there is little guidance as to how these tools and their content should be designed. Through all activities, we found great support among participating users for strengths-focused apps, and we can consider such apps to be both appropriate and valuable. This paper illustrates how combining a range of user-, researcher-, literature-, and designer-based methods can contribute to creating mHealth tools to support people with chronic illnesses to find and use more of their own personal strengths. %M 32706651 %R 10.2196/18049 %U http://formative.jmir.org/2020/7/e18049/ %U https://doi.org/10.2196/18049 %U http://www.ncbi.nlm.nih.gov/pubmed/32706651 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e12417 %T Continuous 7-Month Internet of Things–Based Monitoring of Health Parameters of Pregnant and Postpartum Women: Prospective Observational Feasibility Study %A Saarikko,Johanna %A Niela-Vilen,Hannakaisa %A Ekholm,Eeva %A Hamari,Lotta %A Azimi,Iman %A Liljeberg,Pasi %A Rahmani,Amir M %A Löyttyniemi,Eliisa %A Axelin,Anna %+ School of Nursing and Department of Computer Science, University of California, 106D Berk Hall, Irvine, CA, 92697-3959, United States, 1 949 824 3590, a.rahmani@uci.edu %K prenatal care %K postnatal care %K wearable electronics %K biosensing %K cloud computing %K mHealth %K physical activity %K sleep %K heart rate %D 2020 %7 24.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Monitoring during pregnancy is vital to ensure the mother’s and infant’s health. Remote continuous monitoring provides health care professionals with significant opportunities to observe health-related parameters in their patients and to detect any pathological signs at an early stage of pregnancy, and may thus partially replace traditional appointments. Objective: This study aimed to evaluate the feasibility of continuously monitoring the health parameters (physical activity, sleep, and heart rate) of nulliparous women throughout pregnancy and until 1 month postpartum, with a smart wristband and an Internet of Things (IoT)–based monitoring system. Methods: This prospective observational feasibility study used a convenience sample of 20 nulliparous women from the Hospital District of Southwest Finland. Continuous monitoring of physical activity/step counts, sleep, and heart rate was performed with a smart wristband for 24 hours a day, 7 days a week over 7 months (6 months during pregnancy and 1 month postpartum). The smart wristband was connected to a cloud server. The total number of possible monitoring days during pregnancy weeks 13 to 42 was 203 days and 28 days in the postpartum period. Results: Valid physical activity data were available for a median of 144 (range 13-188) days (75% of possible monitoring days), and valid sleep data were available for a median of 137 (range 0-184) days (72% of possible monitoring days) per participant during pregnancy. During the postpartum period, a median of 15 (range 0-25) days (54% of possible monitoring days) of valid physical activity data and 16 (range 0-27) days (57% of possible monitoring days) of valid sleep data were available. Physical activity decreased from the second trimester to the third trimester by a mean of 1793 (95% CI 1039-2548) steps per day (P<.001). The decrease continued by a mean of 1339 (95% CI 474-2205) steps to the postpartum period (P=.004). Sleep during pregnancy also decreased from the second trimester to the third trimester by a mean of 20 minutes (95% CI –0.7 to 42 minutes; P=.06) and sleep time shortened an additional 1 hour (95% CI 39 minutes to 1.5 hours) after delivery (P<.001). The mean resting heart rate increased toward the third trimester and returned to the early pregnancy level during the postpartum period. Conclusions: The smart wristband with IoT technology was a feasible system for collecting representative data on continuous variables of health parameters during pregnancy. Continuous monitoring provides real-time information between scheduled appointments and thus may help target and tailor pregnancy follow-up. %M 32706696 %R 10.2196/12417 %U http://formative.jmir.org/2020/7/e12417/ %U https://doi.org/10.2196/12417 %U http://www.ncbi.nlm.nih.gov/pubmed/32706696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e17712 %T Internet-Based Cognitive-Behavioral Therapy for College Students With Anxiety, Depression, Social Anxiety, or Insomnia: Four Single-Group Longitudinal Studies of Archival Commercial Data and Replication of Employee User Study %A Attridge,Mark D %A Morfitt,Russell C %A Roseborough,David J %A Jones,Edward R %+ Attridge Consulting, Inc, 1129 Cedar Lake Rd S, Minneapolis, MN, United States, 1 612 889 2398, mark@attridgeconsulting.com %K anxiety %K cognitive behavioral %K college %K depression %K insomnia %K mental health %K social phobia %K stress %D 2020 %7 23.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The growing behavioral health needs of college students have resulted in counseling centers reporting difficulties in meeting student demand. Objective: This study aims to test the real-world voluntary use by college students of 4 digital, self-directed mental health modules based on a cognitive behavioral therapy clinical model. The findings were also compared with those of employee users. Methods: Archival operational data from Learn to Live were extracted for student users at 4 colleges and universities in the Midwest region of the United States (N=951). The inclusion criteria were having clinical symptoms at established levels of moderate or higher severity and the use of 2 or more of the 8 lessons of a program within a 6-month period. Unique users in each program included 347 for depression; 325 for stress, anxiety, and worry; 203 for social anxiety; and 76 for insomnia. Paired t tests (two-tailed) compared the average level of change over time on a standardized measure of clinical symptoms appropriate to each program. Cohen d statistical effect sizes were calculated for each program. Potential moderator factors (age, gender, preliminary comprehensive assessment, number of lessons, duration, live coach support, and live teammate support) were tested together in repeated measures analysis of variance models with covariates in the full sample. Follow-up survey data (n=136) were also collected to explore user satisfaction and outcomes. Select data from another study of the same 4 programs by employee users meeting the same criteria (N=707) were examined for comparison. Results: The percentage of users who improved to a clinical status of no longer being at risk after program use was as follows: stress, anxiety, and worry program (149/325, 45.8%); insomnia program (33/76, 43.4%), depression program (124/347, 35.7%); and social anxiety program (45/203, 22.2%). Significant improvements (all P<.001) over time were found in the mean scores for the clinical measures for each program: stress, anxiety, and worry (t324=16.21; d=1.25); insomnia (t75=6.85; d=1.10); depression (t346=12.71; d=0.91); and social anxiety (t202=8.33; d=0.80). Tests of the moderating factors across programs indicated that greater improvement was strongly associated with the use of more lessons and it also differed by program, by gender (males demonstrated more improvement than females), and by the use of live support (particularly coaching). Analyses of survey data found high satisfaction, improved academic outcomes, and successful integration into the university counseling ecosystem. The operational profile and outcomes of the college students were also similar to those of employee users of the same programs from our other study of employee users. Thus, this study provides a replication. Conclusions: Self-directed internet-based cognitive behavioral therapy mental health modules are promising as a supplement to traditional in-person counseling services provided by college counseling centers. %M 32706662 %R 10.2196/17712 %U http://formative.jmir.org/2020/7/e17712/ %U https://doi.org/10.2196/17712 %U http://www.ncbi.nlm.nih.gov/pubmed/32706662 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e19364 %T A Novel Educational Control Group Mobile App for Meditation Interventions: Single-Group Feasibility Trial %A Huberty,Jennifer %A Eckert,Ryan %A Puzia,Megan %A Laird,Breanne %A Larkey,Linda %A Mesa,Ruben %+ College of Health Solutions, Arizona State University, 500 North 3rd Street, Phoenix, AZ, 85004, United States, 1 402 301 1304, jhuberty@asu.edu %K feasibility %K smartphone %K mHealth %K digital health %K cancer %K beta test %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphone ownership is becoming ubiquitous among US adults, making the delivery of health interventions via a mobile app (ie, mobile health [mHealth]) attractive to many researchers and clinicians. Meditation interventions have become popular and have been delivered to study participants via mobile apps to improve a range of health outcomes in both healthy adults and those with chronic diseases. However, these meditation mHealth interventions have been limited by a lack of high-quality control groups. More specifically, these studies have lacked consistency in their use of active, time-matched, and attention-matched control groups. Objective: The purpose of this study is to beta test a novel health education podcast control condition delivered via a smartphone app that would be a strong comparator to be used in future studies of app-based meditation interventions. Methods: Patients with myeloproliferative neoplasm (MPN) cancer were recruited nationally. Upon enrollment, participants were informed to download the investigator-developed health education podcast app onto their mobile phone and listen to ~60 min/week of cancer-related educational podcasts for 12 weeks. The benchmarks for feasibility included ≥70% of participants completing ≥70% of the prescribed 60 min/week of podcasts, ≥70% of participants reporting that they were satisfied with the intervention, and ≥70% of participants reporting that they enjoyed the health education podcasts. Results: A total of 96 patients with MPN were enrolled in the study; however, 19 never began the intervention. Of the 77 patients who participated in the intervention, 39 completed the entire study (ie, sustained participation through the follow-up period). Participation averaged 103.2 (SD 29.5) min/week. For 83.3% (10/12) of the weeks, at least 70% of participants completed at least 70% of their total prescribed use. Almost half of participants reported that they enjoyed the health education podcasts (19/39, 48.7%) and were satisfied with the intervention (17/39, 43.6%). There were no significant changes in cancer-related outcomes from baseline to postintervention. Conclusions: A 12-week, health education podcast mobile app was demanded but not accepted in a sample of patients with cancer. Using the mobile app was not associated with significant changes in cancer-related symptoms. Based on findings from this study, a health education podcast mobile app may be a feasible option as a time- and attention-matched control group for efficacy trials with more extensive formative research for the content of the podcasts and its acceptability by the specific population. Trial Registration: ClinicalTrials.gov NCT03907774; https://clinicaltrials.gov/ct2/show/NCT03907774 %M 32706719 %R 10.2196/19364 %U http://formative.jmir.org/2020/7/e19364/ %U https://doi.org/10.2196/19364 %U http://www.ncbi.nlm.nih.gov/pubmed/32706719 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e17441 %T A Digital Library for Increasing Awareness About Living Donor Kidney Transplants: Formative Study %A Waterman,Amy D %A Wood,Emily H %A Ranasinghe,Omesh N %A Faye Lipsey,Amanda %A Anderson,Crystal %A Balliet,Wendy %A Holland-Carter,Lauren %A Maurer,Stacey %A Aurora Posadas Salas,Maria %+ Division of Nephrology, David Geffen School of Medicine, University of California, Los Angeles, 1018 Westwood Blvd, Los Angeles, CA, 90024, United States, 1 4243277278, awaterman@mednet.ucla.edu %K living donor kidney transplant %K living donation %K health education %K informed decision-making %K awareness %K health literacy %K video library %K health technology %K kidney diseases %K diffusion of innovation %K digital library %K mobile phone %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: It is not common for people to come across a living kidney donor, let alone consider whether they would ever donate a kidney themselves while they are alive. Narrative storytelling, the sharing of first-person narratives based on lived experience, may be an important way to improve education about living donor kidney transplants (LDKTs). Developing ways to easily standardize and disseminate diverse living donor stories using digital technology could inspire more people to consider becoming living donors and reduce the kidney shortage nationally. Objective: This paper aimed to describe the development of the Living Donation Storytelling Project, a web-based digital library of living donation narratives from multiple audiences using video capture technology. Specifically, we aimed to describe the theoretical foundation and development of the library, a protocol to capture diverse storytellers, the characteristics and experiences of participating storytellers, and the frequency with which any ethical concerns about the content being shared emerged. Methods: This study invited kidney transplant recipients who had received LDKTs, living donors, family members, and patients seeking LDKTs to record personal stories using video capture technology by answering a series of guided prompts on their computer or smartphone and answering questions about their filming experience. The digital software automatically spliced responses to open-ended prompts, creating a seamless story available for uploading to a web-based library and posting to social media. Each story was reviewed by a transplant professional for the disclosure of protected health information (PHI), pressuring others to donate, and medical inaccuracies. Disclosures were edited. Results: This study recruited diverse storytellers through social media, support groups, churches, and transplant programs. Of the 137 storytellers who completed the postsurvey, 105/137 (76.6%) were white and 99/137 (72.2%) were female. They spent 62.5 min, on average, recording their story, with a final median story length of 10 min (00:46 seconds to 32:16 min). A total of 94.8% (130/137) of storytellers were motivated by a desire to educate the public; 78.1% (107/137) were motivated to help more people become living donors; and 75.9% (104/137) were motivated to dispel myths. The ease of using the technology and telling their story varied, with the fear of being on film, emotional difficulty talking about their experiences, and some technological barriers being reported. PHI, most commonly surnames and transplant center names, was present in 62.9% (85/135) of stories and was edited out. Conclusions: With appropriate sensitivity to ensure diverse recruitment, ethical review of content, and support for storytellers, web-based storytelling platforms may be a cost-effective and convenient way to further engage patients and increase the curiosity of the public in learning more about the possibility of becoming living donors. %M 32480362 %R 10.2196/17441 %U https://formative.jmir.org/2020/7/e17441 %U https://doi.org/10.2196/17441 %U http://www.ncbi.nlm.nih.gov/pubmed/32480362 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17703 %T Untold Stories in User-Centered Design of Mobile Health: Practical Challenges and Strategies Learned From the Design and Evaluation of an App for Older Adults With Heart Failure %A Cornet,Victor Philip %A Toscos,Tammy %A Bolchini,Davide %A Rohani Ghahari,Romisa %A Ahmed,Ryan %A Daley,Carly %A Mirro,Michael J %A Holden,Richard J %+ Regenstrief Institute, 1101 W 10th St #421, Indianapolis, IN, 46202, United States, 1 317 278 5323, rjholden@iu.edu %K user-centered design %K research methods %K mobile health %K digital health %K mobile apps %K usability %K technology %K evaluation %K human-computer interaction %K mobile phone %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: User-centered design (UCD) is a powerful framework for creating useful, easy-to-use, and satisfying mobile health (mHealth) apps. However, the literature seldom reports the practical challenges of implementing UCD, particularly in the field of mHealth. Objective: This study aims to characterize the practical challenges encountered and propose strategies when implementing UCD for mHealth. Methods: Our multidisciplinary team implemented a UCD process to design and evaluate a mobile app for older adults with heart failure. During and after this process, we documented the challenges the team encountered and the strategies they used or considered using to address those challenges. Results: We identified 12 challenges, 3 about UCD as a whole and 9 across the UCD stages of formative research, design, and evaluation. Challenges included the timing of stakeholder involvement, overcoming designers’ assumptions, adapting methods to end users, and managing heterogeneity among stakeholders. To address these challenges, practical recommendations are provided to UCD researchers and practitioners. Conclusions: UCD is a gold standard approach that is increasingly adopted for mHealth projects. Although UCD methods are well-described and easily accessible, practical challenges and strategies for implementing them are underreported. To improve the implementation of UCD for mHealth, we must tell and learn from these traditionally untold stories. %M 32706745 %R 10.2196/17703 %U http://mhealth.jmir.org/2020/7/e17703/ %U https://doi.org/10.2196/17703 %U http://www.ncbi.nlm.nih.gov/pubmed/32706745 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e14951 %T Sedentary Work in Desk-Dominated Environments: A Data-Driven Intervention Using Intervention Mapping %A Berninger,Nathalie M %A ten Hoor,Gill A %A Plasqui,Guy %A Kok,Gerjo %A Peters,Gjalt-Jorn Ygram %A Ruiter,Robert A C %+ Department of Work and Social Psychology, Maastricht University, PO Box 616, WSP, Universiteitssingel 40, Maastricht, Netherlands, 31 433881908, nathalie.berninger@maastrichtuniversity.nl %K intervention mapping %K sedentary behavior %K sedentary work %K computer-based %K occupational health %K eHealth %K mHealth %K data-driven programs %D 2020 %7 20.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Since desk-dominated work environments facilitate sedentary behavior, office workers sit for 66% of their working days and only 8% succeed in interrupting their prolonged periods of sitting within the first 55 minutes. Yet stretches of long and uninterrupted sitting increase the likelihood of several chronic metabolic and cardiovascular diseases. Objective: We therefore developed a computer-based app designed to interrupt periods of prolonged sitting among office employees. Methods: When developing the intervention, we applied the intervention mapping protocol. This approach for the systematic design of theory and evidence-based behavior change programs consists of 6 steps: creation of a logic model of the problem, creation of a logic model of change, program design, program production, design of an implementation plan, and development of an evaluation plan. Results: Working through all 6 steps has resulted in an individually adaptable intervention to reduce sedentary behavior at work. The intervention, UPcomplish, consists of tailored, half-automatized motivational components delivered by a coach. To register sedentary behavior, the VitaBit (VitaBit Software International BV) toolkit, a wearable accelerometry-based monitoring device, is used. Among others, UPcomplish includes personalized goal setting, tailored suggestions to overcome hurdles, and weekly challenges. The VitaBit toolkit supports the participants to monitor their behavior in relation to self-set goals. Conclusions: Intervention mapping is a useful protocol not only for the systematic development of a comprehensive intervention to reduce sedentary behavior but also for planning program adherence, program implementation, and program maintenance. It facilitates obtaining the participation of relevant stakeholders at different ecological levels in the development process of the intervention and anticipating facilitators to and barriers of program implementation and maintenance. Trial Registration: Netherlands Trial Register NL7503; https://www.trialregister.nl/trial/7503 %M 32706695 %R 10.2196/14951 %U http://formative.jmir.org/2020/7/e14951/ %U https://doi.org/10.2196/14951 %U http://www.ncbi.nlm.nih.gov/pubmed/32706695 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e16455 %T Effectiveness of a Voice-Based Mental Health Evaluation System for Mobile Devices: Prospective Study %A Higuchi,Masakazu %A Nakamura,Mitsuteru %A Shinohara,Shuji %A Omiya,Yasuhiro %A Takano,Takeshi %A Mitsuyoshi,Shunji %A Tokuno,Shinichi %+ Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, , Japan, 81 3 5841 3432, higuchi@bioeng.t.u-tokyo.ac.jp %K mental health %K monitoring system %K stress evaluation %K voice analysis %D 2020 %7 20.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: We developed a system for monitoring mental health using voice data from daily phone calls, termed Mind Monitoring System (MIMOSYS), by implementing a method for estimating mental health status from voice data. Objective: The objective of this study was to evaluate the potential of this system for detecting depressive states and monitoring stress-induced mental changes. Methods: We opened our system to the public in the form of a prospective study in which data were collected over 2 years from a large, unspecified sample of users. We used these data to analyze the relationships between the rate of continued use, the men-to-women ratio, and existing psychological tests for this system over the study duration. Moreover, we analyzed changes in mental data over time under stress from particular life events. Results: The system had a high rate of continued use. Voice indicators showed that women have more depressive tendencies than men, matching the rate of depression in Japan. The system’s voice indicators and the scores on classical psychological tests were correlated. We confirmed deteriorating mental health for users in areas affected by major earthquakes in Japan around the time of the earthquakes. Conclusions: The results suggest that although this system is insufficient for detecting depression, it may be effective for monitoring changes in mental health due to stress. The greatest feature of our system is mental health monitoring, which is most effectively accomplished by performing long-term time-series analysis of the acquired data considering the user’s life events. Such a system can improve the implementation of patient interventions by evaluating objective data along with life events. %M 32554367 %R 10.2196/16455 %U http://formative.jmir.org/2020/7/e16455/ %U https://doi.org/10.2196/16455 %U http://www.ncbi.nlm.nih.gov/pubmed/32554367 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e13650 %T What College Students Post About Depression on Facebook and the Support They Perceive: Content Analysis %A Cash,Scottye %A Schwab-Reese,Laura Marie %A Zipfel,Erin %A Wilt,Megan %A Moreno,Megan %+ College of Social Work, The Ohio State University, 1947 College Rd, Columbus, OH, 43210, United States, 1 614 292 3690, cash.33@osu.edu %K social media %K depression %K college students %K qualitative %D 2020 %7 17.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: College students frequently use social media sites to connect with friends. Increasingly, research suggests college students and other young adults seek mental health-related support on social media, which may present a unique venue for intervention. Objective: The purpose of this study was to examine college students’ perceptions about displaying feelings of depression on Facebook and, in turn, how their social media friends responded. Methods: A primarily quantitative online survey with open response questions was distributed to students at four US universities. Qualitative responses were analyzed using content analysis. Results: A total of 34 students provided qualitative responses for analysis, these students were 85.3% female, mean age 20.2 (SD=1.4) and 20.6% racial/ethnic minority. Students who reported posting about depression often expressed an emotion or feeling but did not use the word “depression” in the post. Approximately 20% posted language about a bad day, and 15% posted a song or music video. Only one person reported posting a statement that directly asked for help. When friends responded to the posts, students generally perceived the responses as supportive or motivating gestures. Nearly 15% of friends contacted the individual outside of Facebook. One individual received a negative response and no responses suggested that the individual seek help. Conclusions: This study found that college students who post about depression often do so without directly referencing depression and that friends were generally supportive. However, no participants reported their social network suggested they seek help, which may suggest increasing mental health literacy, for both support seekers and responders, would be an opportunity to improve online mental health-related support. %M 32706687 %R 10.2196/13650 %U https://formative.jmir.org/2020/7/e13650 %U https://doi.org/10.2196/13650 %U http://www.ncbi.nlm.nih.gov/pubmed/32706687 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e17293 %T Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study %A Darnall,Beth D %A Krishnamurthy,Parthasarathy %A Tsuei,Jeannette %A Minor,Jorge D %+ Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 1070 Arastradero Road, Suite 200, MC 5596, Palo Alto, CA, 94304, United States, 1 (650) 725 9642, bdarnall@stanford.edu %K chronic pain %K virtual reality %K behavioral medicine %K self-management %K mobile phone %K randomized controlled trial %D 2020 %7 7.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with chronic pain often have limited access to comprehensive care that includes behavioral pain management strategies. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapy with analgesic efficacy for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations. Objective: The primary aim of this study is to evaluate the feasibility of a self-administered VR program that included content and skills informed by evidence-based behavioral treatment for chronic pain. The secondary aim is to determine the preliminary efficacy of the VR program in terms of average pain intensity and pain-related interference with activity, stress, mood, and sleep, and its impact on pain-related cognition and self-efficacy. The tertiary aim was to conduct a randomized controlled trial (RCT) and compare the VR treatment with an audio-only treatment. This comparison isolated the immersive effects of the VR program, thereby informing potential mechanisms of effect. Methods: We conducted an RCT involving a web-based convenience sample of adults (N=97) aged 18-75 years with self-reported chronic nonmalignant low back pain or fibromyalgia, with an average pain intensity >4 over the past month and chronic pain duration >6 months. Enrolled participants were randomly assigned to 1 of 2 unblinded treatments: (1) VR: a 21-day, skills-based VR program for chronic pain; and (2) audio: an audio-only version of the 21-day VR program. The analytic data set included participants who completed at least 1 of 8 surveys administered during the intervention period: VR (n=39) and audio (n=35). Results: The VR and audio groups launched a total of 1067 and 1048 sessions, respectively. The majority of VR participants (n=19/25, 76%) reported no nausea or motion sickness. High satisfaction ratings were reported for VR (n=24/29, 83%) and audio (n=26/33, 72%). For VR efficacy, symptom improvement over time was found for each pain variable (all P<.001), with results strengthening after 2 weeks. Importantly, significant time×group effects were found in favor of the VR group for average pain intensity (P=.04), pain-related inference with activity (P=.005), sleep (P<.001), mood (P<.001), and stress (P=.003). For pain catastrophizing and pain self-efficacy, we found a significant declining trend for both treatment groups. Conclusions: High engagement and satisfaction combined with low levels of adverse effects support the feasibility and acceptability of at-home skills-based VR for chronic pain. A significant reduction in pain outcomes over the course of the 21-day treatment both within the VR group and compared with an audio-only version suggests that VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain. %M 32374272 %R 10.2196/17293 %U https://formative.jmir.org/2020/7/e17293 %U https://doi.org/10.2196/17293 %U http://www.ncbi.nlm.nih.gov/pubmed/32374272 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e14161 %T Usability and Acceptability of a Smartphone App to Assess Partner Communication, Closeness, Mood, and Relationship Satisfaction: Mixed Methods Study %A Langer,Shelby L %A Ghosh,Neeta %A Todd,Michael %A Randall,Ashley K %A Romano,Joan M %A Bricker,Jonathan B %A Bolger,Niall %A Burns,John W %A Hagan,Rachel C %A Porter,Laura S %+ Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 North Third Street, Phoenix, AZ, 85004, United States, 1 6024960823, shelby.langer@asu.edu %K ecological momentary assessment %K smartphone %K mobile phone %K communication %K disclosure %K affect %D 2020 %7 6.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Interpersonal communication is critical for a healthy romantic relationship. Emotional disclosure, coupled with perceived partner responsiveness, fosters closeness and adjustment (better mood and relationship satisfaction). On the contrary, holding back from disclosure is associated with increased distress and decreased relationship satisfaction. Prior studies assessing these constructs have been cross-sectional and have utilized global retrospective reports of communication. In addition, studies assessing holding back or perceived partner responsiveness have not taken advantage of smartphone ownership for data collection and have instead required website access or use of a study-provided device. Objective: This study aimed to examine the (1) usability and acceptability of a smartphone app designed to assess partner communication, closeness, mood, and relationship satisfaction over 14 days and (2) between-person versus within-person variability of key constructs to inform the utility of their capture via ecological momentary assessment using the participants’ own handheld devices. Methods: Adult community volunteers in a married or cohabiting partnered relationship received 2 smartphone prompts per day, one in the afternoon and one in the evening, for 14 days. In each prompt, participants were asked whether they had conversed with their partner either since awakening (afternoon prompt) or since the last assessment (evening prompt). If yes, a series of items assessed enacted communication, perceived partner communication, closeness, mood, and relationship satisfaction (evening only). Participants were interviewed by phone, 1 week after the end of the 14-day phase, to assess perceptions of the app. Content analysis was employed to identify key themes. Results: Participants (N=27; mean age 36, SD 12 years; 24/27, 89% female; 25/27, 93% white and 2/27, 7% Hispanic) responded to 79.2% (555/701) of the total prompts sent and completed 553 (78.9%) of those assessments. Of the responded prompts, 79.3% (440/555) were characterized by a report of having conversed with one’s partner. The app was seen as highly convenient (mean 4.15, SD 0.78, scale: 1-5) and easy to use (mean 4.39, SD 0.70, scale: 1-5). Qualitative analyses indicated that participants found the app generally easy to navigate, but the response window too short (45 min) and the random nature of receiving notifications vexing. With regard to the variability of the app-delivered items, intraclass correlation coefficients were generally <0.40, indicating that the majority of the variability in each measure was at the within-person level. Notable exceptions were enacted disclosure and relationship satisfaction. Conclusions: The findings of this study support the usability and acceptability of the app, with valuable user input to modify timing windows in future work. The findings also underscore the utility of an intensive repeated-measures approach, given the meaningful day-to-day variation (greater within-person vs between-person variability) in communication and mood. %M 32628614 %R 10.2196/14161 %U https://formative.jmir.org/2020/7/e14161 %U https://doi.org/10.2196/14161 %U http://www.ncbi.nlm.nih.gov/pubmed/32628614 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e17722 %T Use of a Mobile App to Augment Psychotherapy in a Community Psychiatric Clinic: Feasibility and Fidelity Trial %A Adam,Atif %A Jain,Ameena %A Pletnikova,Alexandra %A Bagga,Rishi %A Vita,Allison %A N Richey,Lisa %A Gould,Neda %A Munshaw,Supriya %A Misrilall,Kavi %A Peters,Matthew E %+ Rose: Smarter Mental Health, 3400 Prospect St NW, Washington, DC, 20007, United States, 1 4103363626, dratif@askrose.com %K mobile app %K mental health %K depression %K anxiety %D 2020 %7 3.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Even though 1 in 5 Americans experience some form of mental illness each year, 80% have been shown to discontinue psychotherapy prematurely. The traditional psychotherapy service delivery model, consisting of isolated clinical sessions, lacks the ability to keep patients engaged outside clinical sessions. Newer digital mental health platforms can address the clinical need for a robust tool that tracks mental well-being and improves engagement in patients with depressive symptoms. Objective: The primary goals of this feasibility study were to (1) assess compliance among providers and their patients with a digital mental health platform protocol, and (2) examine the usability and fidelity of a mobile app through structured participant feedback. Methods: A sample of 30 participants was recruited for a 5-week study from a community-based mental health clinic in Baltimore, Maryland, USA. Inclusion criteria were: aged 18 years or older, having access to a smartphone, and having at least mild-to-moderate depression and/or anxiety as measured by the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales, respectively. Eligible participants were randomized into one of two study arms: (1) the intervention arm or (2) the waitlist control arm. Participants in the intervention arm were asked to download the Rose app and were prompted to complete clinical assessments (PHQ-9 and GAD-7) every other week, daily mood and anxiety Likert scales, and daily journal entries. The participants in the waitlist arm served as controls for the study and completed the clinical assessments only. Both arms engaged in weekly psychotherapy sessions, with participant in-app input informing the psychotherapy process of the intervention arm, while those in the waitlist control arm continued their standard care. Outcomes of interest included adherence to completion of in-app assessments and usability of the Rose mobile app assessed through the modified Mobile Application Rating Scale. Results: Over the study period, a sample of 30 participants used the Rose app 2834 times to complete clinical assessments. On average, 70% (21; 95% CI 61.14%-77.41%) of participants completed mood and anxiety daily check-ins and journal entries 5 days per week. Nearly all participants (29/30, 97%) completed all PHQ-9 and GAD-7 in-app scales during the study. Subjective impressions showed that 73% (22/30) of participants found the mobile app to be engaging and in line with their needs, and approximately 70% (21/30) of participants reported the app functionality and quality of information to be excellent. Additionally, more than two-thirds of the participants felt that their knowledge and awareness of depression and anxiety management improved through using the app. Conclusions: Steady compliance and high app ratings showcase the utility of the Rose mobile mental health app in augmenting the psychotherapy process for patients with mood disorders and improving mental health knowledge. Future studies are needed to further examine the impact of Rose on treatment outcomes. Trial Registration: ClinicalTrials.gov NCT04200170; https://clinicaltrials.gov/ct2/show/NCT04200170 %M 32618572 %R 10.2196/17722 %U https://formative.jmir.org/2020/7/e17722 %U https://doi.org/10.2196/17722 %U http://www.ncbi.nlm.nih.gov/pubmed/32618572 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e15295 %T Patient and Parent Perspectives on Improving Pediatric Asthma Self-Management Through a Mobile Health Intervention: Pilot Study %A Nichols,Michelle %A Miller,Sarah %A Treiber,Frank %A Ruggiero,Kenneth %A Dawley,Erin %A Teufel II,Ronald %+ College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, MSC 160, Charleston, SC, 29425, United States, 1 8437921802, nicholmg@musc.edu %K asthma %K mobile health %K ecological momentary assessment %K adolescents %K medication adherence %K self-management %K mobile phone %D 2020 %7 3.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Asthma is a common chronic pediatric disease that can negatively impact children and families. Self-management strategies are challenging to adopt but critical for achieving positive outcomes. Mobile health technology may facilitate self-management of pediatric asthma, especially as adolescents mature and assume responsibility for their disease. Objective: This study aimed to explore the perceptions of youths with high-risk asthma and their caregivers on the use of a smartphone app, Smartphone Asthma Management System, in the prevention and treatment of asthma symptoms, possible use of the app to improve self-management of asthma outside traditional clinical settings, and the impact of asthma on everyday life to identify potential needs for future intervention development. Methods: Key informant interviews were completed with parent-child dyads post participation in an asthma management feasibility intervention study to explore the perceptions of users on a smartphone app designed to monitor symptoms and medication use and offer synchronous and asynchronous provider encounters. A thematic qualitative analysis was conducted inductively through emergent findings and deductively based on the self-determination theory (SDT), identifying 4 major themes. Results: A total of 19 parent-child dyads completed the postintervention interviews. The major themes identified included autonomy, competence, relatedness, and the impact of asthma on life. The participants also shared their perceptions of the benefits and challenges associated with using the app and in the self-management of asthma. Both children and parents conveyed a preference for using technology to facilitate medication and disease management, and children demonstrated a strong willingness and ability to actively engage in their care. Conclusions: Our study included support for the app and demonstrated the feasibility of enhancing the self-management of asthma by youth in the community. Participant feedback led to intervention refinement and app improvements, and the use of the SDT allowed insight into motivational drivers of behavioral change. The use of mobile apps among high-risk children with asthma and their parents shows promise in improving self-management, medication adherence, and disease awareness and in reducing overall disease morbidity. %M 32442127 %R 10.2196/15295 %U https://formative.jmir.org/2020/7/e15295 %U https://doi.org/10.2196/15295 %U http://www.ncbi.nlm.nih.gov/pubmed/32442127 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e14486 %T Barriers to Gestational Diabetes Management and Preferred Interventions for Women With Gestational Diabetes in Singapore: Mixed Methods Study %A Hewage,Sumali %A Audimulam,Jananie %A Sullivan,Emily %A Chi,Claudia %A Yew,Tong Wei %A Yoong,Joanne %+ Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore, 65 65164988, sumali_hewage@u.nus.edu %K gestational diabetes %K pregnancy %K telemedicine %K self-management %K patient-centered care %K mobile phone %D 2020 %7 30.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Gestational diabetes mellitus (GDM) is associated with risks for both the mother and child. The escalated prevalence of GDM because of obesity and changes in screening criteria demands for greater health care needs than before. Objective: This study aimed to understand the perception of patients and health care providers of the barriers to GDM management and preferred interventions to manage GDM in an Asian setting. Methods: This mixed methods study used a convergent parallel design. Survey data were collected from 216 women with GDM, and semistructured interviews were conducted with 15 women and with 8 health care providers treating patients with GDM. Participants were recruited from 2 specialized GDM clinics at the National University Hospital, Singapore. Results: The patients were predominantly Chinese (102/214, 47.6%), employed (201/272, 73.9%), with higher education (150/216, 69.4%) and prenatal attendance at a private clinic (138/214, 64.2%), already on diet control (210/214, 98.1%), and receiving support and information from the GDM clinic (194/215, 90.2%) and web-based sources (131/215, 60.9%). In particular, working women reported barriers to GDM management, including the lack of reminders for blood glucose monitoring, diet control, and insufficient time for exercise. Most women preferred getting such support directly from health care providers, whether at the GDM clinic (174/215, 80.9%) or elsewhere (116/215, 53.9%). Smartphone apps were the preferred means of additional intervention. Desirable intervention features identified by patients included more information on GDM, diet and exercise options, reminders for blood glucose testing, a platform to record blood glucose readings and illustrate or understand trends, and a means to communicate with care providers. Conclusions: A GDM-focused smartphone app that is able to integrate testing, education, and communication may be a feasible and acceptable intervention to provide support to women with GDM, particularly for working women. %M 32602845 %R 10.2196/14486 %U http://formative.jmir.org/2020/6/e14486/ %U https://doi.org/10.2196/14486 %U http://www.ncbi.nlm.nih.gov/pubmed/32602845 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e15777 %T Smartphone Self-Monitoring by Young Adolescents and Parents to Assess and Improve Family Functioning: Qualitative Feasibility Study %A Swendeman,Dallas %A Sumstine,Stephanie %A Brink,Amber %A Mindry,Deborah %A Medich,Melissa %A Russell,Michael %+ Global Center for Children and Families, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA, 90024, United States, 1 3107948158, dswendeman@mednet.ucla.edu %K adolescents %K parenting %K conflict %K self-monitoring %K smartphones %K mHealth %K ecological momentary assessment %K mobile phone %D 2020 %7 23.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The natural integration of mobile phones into the daily routines of families provides novel opportunities to study and support family functioning and the quality of interactions between family members in real time. Objective: This study aimed to examine user experiences of feasibility, acceptability, and reactivity (ie, changes in awareness and behaviors) of using a smartphone app for self-monitoring of family functioning with 36 participants across 15 family dyads and triads of young adolescents aged 10 to 14 years and their parents. Methods: Participants were recruited from 2 family wellness centers in a middle-to-upper income shopping area and a low-income school site. Participants were instructed and prompted by alarms to complete ecological momentary assessments (EMAs) by using a smartphone app over 2 weeks 4 times daily (upon waking in the morning, afternoon, early evening, and end of day at bedtime). The domains assessed included parental monitoring and positive parenting, parent involvement and discipline, parent-child conflict and resolution, positive interactions and support, positive and negative affect, sleep, stress, family meals, and general child and family functioning. Qualitative interviews assessed user experiences generally and with prompts for positive and negative feedback. Results: The participants were primarily white and Latino of mixed-income- and education levels. Children were aged 10 to 14 years, and parents had a mean age of 45 years (range 37-50). EMA response rates were high (95% to over 100%), likely because of cash incentives for EMA completion, engaging content per user feedback, and motivated sample from recruitment sites focused on social-emotional programs for family wellness. Some participants responded for up to 19 days, consistent with some user experience interview feedback of desires to continue participation for up to 3 or 4 weeks. Over 80% (25/31) of participants reported increased awareness of their families’ daily routines and functioning of their families. Most also reported positive behavior changes in the following domains: decision making, parental monitoring, quantity and quality of time together, communication, self-regulation of stress and conflict, discipline, and sleep. Conclusions: The results of this study support the feasibility and acceptability of using smartphone EMA by young adolescents and parents for assessing and self-monitoring family daily routines and interactions. The findings also suggest that smartphone self-monitoring may be a useful tool to support improvement in family functioning through functions of reflection on antecedents and consequences of situations, prompting positive and negative alternatives, seeding goals, and reinforcement by self-tracking for self-correction and self-rewards. Future studies should include larger samples with more diverse and higher-risk populations, longer study durations, the inclusion of passive phone sensors and peripheral biometric devices, and integration with counseling and parenting interventions and programs. %M 32574148 %R 10.2196/15777 %U http://formative.jmir.org/2020/6/e15777/ %U https://doi.org/10.2196/15777 %U http://www.ncbi.nlm.nih.gov/pubmed/32574148 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e18890 %T Adherence of the #Here4U App – Military Version to Criteria for the Development of Rigorous Mental Health Apps %A Linden,Brooke %A Tam-Seto,Linna %A Stuart,Heather %+ Health Services and Policy Research Institute, Queen's University, 21 Arch Street, Kingston, ON, K7L 3L3, Canada, 1 613 533 6387, brooke.linden@queensu.ca %K mental health services %K telemedicine %K mHealth %K chatbot %K e-solutions %K Canadian Armed Forces %K military health %K mobile phone %D 2020 %7 17.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Over the past several years, the emergence of mobile mental health apps has increased as a potential solution for populations who may face logistical and social barriers to traditional service delivery, including individuals connected to the military. Objective: The goal of the #Here4U App – Military Version is to provide evidence-informed mental health support to members of Canada’s military community, leveraging artificial intelligence in the form of IBM Canada’s Watson Assistant to carry on unique text-based conversations with users, identify presenting mental health concerns, and refer users to self-help resources or recommend professional health care where appropriate. Methods: As the availability and use of mental health apps has increased, so too has the list of recommendations and guidelines for efficacious development. We describe the development and testing conducted between 2018 and 2020 and assess the quality of the #Here4U App against 16 criteria for rigorous mental health app development, as identified by Bakker and colleagues in 2016. Results: The #Here4U App – Military Version met the majority of Bakker and colleagues’ criteria, with those unmet considered not applicable to this particular product or out of scope for research conducted to date. Notably, a formal evaluation of the efficacy of the app is a major priority moving forward. Conclusions: The #Here4U App – Military Version is a promising new mental health e-solution for members of the Canadian Armed Forces community, filling many of the gaps left by traditional service delivery. %M 32554374 %R 10.2196/18890 %U https://formative.jmir.org/2020/6/e18890 %U https://doi.org/10.2196/18890 %U http://www.ncbi.nlm.nih.gov/pubmed/32554374 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e16072 %T Low-Burden Mobile Monitoring, Intervention, and Real-Time Analysis Using the Wear-IT Framework: Example and Usability Study %A Brick,Timothy R %A Mundie,James %A Weaver,Jonathan %A Fraleigh,Robert %A Oravecz,Zita %+ Department of Human Development and Family Studies, Real-Time Science Laboratory, The Pennsylvania State University, 115 HHD Building, University Park, PA, , United States, 1 8148654868, tbrick@psu.edu %K smartphone apps %K ecological momentary assessment %K real-time analysis %K behavior change %D 2020 %7 17.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) methods often rely on active input from participants, for example, in the form of self-report questionnaires delivered via web or smartphone, to measure health and behavioral indicators and deliver interventions in everyday life settings. For short-term studies or interventions, these techniques are deployed intensively, causing nontrivial participant burden. For cases where the goal is long-term maintenance, limited infrastructure exists to balance information needs with participant constraints. Yet, the increasing precision of passive sensors such as wearable physiology monitors, smartphone-based location history, and internet-of-things devices, in combination with statistical feature selection and adaptive interventions, have begun to make such things possible. Objective: In this paper, we introduced Wear-IT, a smartphone app and cloud framework intended to begin addressing current limitations by allowing researchers to leverage commodity electronics and real-time decision making to optimize the amount of useful data collected while minimizing participant burden. Methods: The Wear-IT framework uses real-time decision making to find more optimal tradeoffs between the utility of data collected and the burden placed on participants. Wear-IT integrates a variety of consumer-grade sensors and provides adaptive, personalized, and low-burden monitoring and intervention. Proof of concept examples are illustrated using artificial data. The results of qualitative interviews with users are provided. Results: Participants provided positive feedback about the ease of use of studies conducted using the Wear-IT framework. Users expressed positivity about their overall experience with the framework and its utility for balancing burden and excitement about future studies that real-time processing will enable. Conclusions: The Wear-IT framework uses a combination of passive monitoring, real-time processing, and adaptive assessment and intervention to provide a balance between high-quality data collection and low participant burden. The framework presents an opportunity to deploy adaptive assessment and intervention designs that use real-time processing and provides a platform to study and overcome the challenges of long-term mHealth intervention. %M 32554373 %R 10.2196/16072 %U https://formative.jmir.org/2020/6/e16072 %U https://doi.org/10.2196/16072 %U http://www.ncbi.nlm.nih.gov/pubmed/32554373 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e7570 %T A Digital Smoking Cessation Program for Heavy Drinkers: Pilot Randomized Controlled Trial %A Kahler,Christopher W %A Cohn,Amy M %A Costantino,Catherine %A Toll,Benjamin A %A Spillane,Nichea S %A Graham,Amanda L %+ Department of Behavioral and Social Sciences, Center for Alcohol and Addiction Studies, Brown University School of Public Health, Box G-S121-4, Providence, RI, United States, 1 4018636651, Christopher_Kahler@brown.edu %K smoking cessation %K alcohol drinking %K internet %K text messaging %K therapy %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Heavy drinking (HD) is far more common among smokers compared with nonsmokers and interferes with successful smoking cessation. Alcohol-focused smoking cessation interventions delivered by counselors have shown promise, but digital versions of these interventions—which could have far greater population reach—have not yet been tested. Objective: This pilot randomized controlled trial aimed to examine the feasibility, acceptability, and effect sizes of an automated digital smoking cessation program that specifically addresses HD using an interactive web-based intervention with an optional text messaging component. Methods: Participants (83/119, 69.7% female; 98/119, 82.4% white; mean age 38.0 years) were daily smokers recruited on the web from a free automated digital smoking cessation program (BecomeAnEX.org, EX) who met the criteria for HD: women drinking 8+ drinks/week or 4+ drinks on any day and men drinking 15+ drinks/week or 5+ drinks on any day. Participants were randomized to receive EX with standard content (EX-S) or an EX with additional content specific to HD (EX-HD). Outcomes were assessed by web-based surveys at 1 and 6 months. Results: Participants reported high satisfaction with the website and the optional text messaging component. Total engagement with both EX-S and EX-HD was modest, with participants visiting the website a median of 2 times, and 52.9% of the participants enrolled to receive text messages. Participants in both the conditions showed substantial, significant reductions in drinking across 6 months of follow-up, with no condition effects observed. Although smoking outcomes tended to favor EX-HD, the condition effects were small and nonsignificant. A significantly smaller proportion of participants in EX-HD reported having a lapse back to smoking when drinking alcohol (7/58, 16%) compared with those in EX-S (18/61, 41%; χ21=6.2; P=.01). Conclusions: This is the first trial to examine a digital smoking cessation program tailored to HD smokers. The results provide some initial evidence that delivering such a program is feasible and may reduce the risk of alcohol-involved smoking lapses. However, increasing engagement in this and other web-based interventions is a crucial challenge to address in future work. Trial Registration: ClinicalTrials.gov NCT03068611; https://clinicaltrials.gov/ct2/show/NCT03068611 %M 32348286 %R 10.2196/formative.7570 %U https://formative.jmir.org/2020/6/e7570 %U https://doi.org/10.2196/formative.7570 %U http://www.ncbi.nlm.nih.gov/pubmed/32348286 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e16371 %T Feasibility of In-Home Sensor Monitoring to Detect Mild Cognitive Impairment in Aging Military Veterans: Prospective Observational Study %A Seelye,Adriana %A Leese,Mira Isabelle %A Dorociak,Katherine %A Bouranis,Nicole %A Mattek,Nora %A Sharma,Nicole %A Beattie,Zachary %A Riley,Thomas %A Lee,Jonathan %A Cosgrove,Kevin %A Fleming,Nicole %A Klinger,Jessica %A Ferguson,John %A Lamberty,Greg John %A Kaye,Jeffrey %+ Minneapolis Veterans Affairs Health Care System, 1 Veterans Dr, Minneapolis, MN, , United States, 1 6127252000, adriana.seelye@va.gov %K aging %K mild cognitive impairment %K activities of daily living %K technology %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Aging military veterans are an important and growing population who are at an elevated risk for developing mild cognitive impairment (MCI) and Alzheimer dementia, which emerge insidiously and progress gradually. Traditional clinic-based assessments are administered infrequently, making these visits less ideal to capture the earliest signals of cognitive and daily functioning decline in older adults. Objective: This study aimed to evaluate the feasibility of a novel ecologically valid assessment approach that integrates passive in-home and mobile technologies to assess instrumental activities of daily living (IADLs) that are not well captured by clinic-based assessment methods in an aging military veteran sample. Methods: Participants included 30 community-dwelling military veterans, classified as healthy controls (mean age 72.8, SD 4.9 years; n=15) or MCI (mean age 74.3, SD 6.0 years; n=15) using the Clinical Dementia Rating Scale. Participants were in relatively good health (mean modified Cumulative Illness Rating Scale score 23.1, SD 2.9) without evidence of depression (mean Geriatrics Depression Scale score 1.3, SD 1.6) or anxiety (mean generalized anxiety disorder questionnaire 1.3, SD 1.3) on self-report measures. Participants were clinically assessed at baseline and 12 months later with health and daily function questionnaires and neuropsychological testing. Daily computer use, medication taking, and physical activity and sleep data were collected via passive computer monitoring software, an instrumented pillbox, and a fitness tracker watch in participants’ environments for 12 months between clinical study visits. Results: Enrollment began in October 2018 and continued until the study groups were filled in January 2019. A total of 201 people called to participate following public posting and focused mailings. Most common exclusionary criteria included nonveteran status 11.4% (23/201), living too far from the study site 9.4% (19/201), and having exclusionary health concerns 17.9% (36/201). Five people have withdrawn from the study: 2 with unanticipated health conditions, 2 living in a vacation home for more than half of the year, and 1 who saw no direct benefit from the research study. At baseline, MCI participants had lower Montreal Cognitive Assessment (P<.001) and higher Functional Activities Questionnaire (P=.04) scores than healthy controls. Over seven months, research personnel visited participants’ homes a total of 73 times for technology maintenance. Technology maintenance visits were more prevalent for MCI participants (P=.04) than healthy controls. Conclusions: Installation and longitudinal deployment of a passive in-home IADL monitoring platform with an older adult military veteran sample was feasible. Knowledge gained from this pilot study will be used to help develop acceptable and effective home-based assessment tools that can be used to passively monitor cognition and daily functioning in older adult samples. %M 32310138 %R 10.2196/16371 %U https://formative.jmir.org/2020/6/e16371 %U https://doi.org/10.2196/16371 %U http://www.ncbi.nlm.nih.gov/pubmed/32310138 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e14550 %T Patients’ User Experience of a Blended Face-to-Face and Web-Based Smoking Cessation Treatment: Qualitative Study %A Siemer,Lutz %A Ben Allouch,Somaya %A Pieterse,Marcel E %A Brusse-Keizer,Marjolein %A Sanderman,Robbert %A Postel,Marloes G %+ Technology, Health & Care Research Group, Saxion University of Applied Sciences, Postbus 70000, Enschede, 7500 KB, Netherlands, 49 17678025906, l.siemer@utwente.nl %K smoking cessation %K cognitive therapy %K blended treatment %K smoking %K user experience %K tobacco %K patient perspective %D 2020 %7 3.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Blended web-based and face-to-face (F2F) treatment is a promising electronic health service because the strengths of one mode of delivery should compensate for the weaknesses of the other. Objective: The aim of this study was to explore this compensation by examining patients’ user experience (UX) in a blended smoking cessation treatment (BSCT) in routine care. Methods: Data on patients’ UX were collected through in-depth interviews (n=10) at an outpatient smoking cessation clinic in the Netherlands. A content analysis of the semantic domains was used to analyze patients’ UX. To describe the UX, the Hassenzahl UX model was applied, examining 4 of the 5 key elements of UX from a user’s perspective: (1) patients’ standards and expectations, (2) apparent character (pragmatic and hedonic attributes), (3) usage situation, and (4) consequences (appeal, emotions, and behavior). Results: BSCT appeared to be a mostly positively experienced service. Patients had a positive-pragmatic standard and neutral-open expectation toward BSCT at the treatment start. The pragmatic attributes of the F2F sessions were mostly perceived as positive, whereas the pragmatic attributes of the web sessions were perceived as both positive and negative. For the hedonic attributes, there seemed to be a difference between the F2F and web sessions. Specifically, the hedonic attributes of the web sessions were experienced as mostly negative, whereas those of the F2F sessions were experienced as mostly positive. For the usage situation, the physical and social contexts were experienced positively, whereas the task and technical contexts were experienced negatively. Nevertheless, the consequential appeal of BSCT was positive. However, the consequential emotions and behavior varied, ultimately resulting in diverse combinations of consequential appeal, emotions, and behavior (positive, negative, and mixed). Conclusions: This study provided insights into the UX of a blended treatment, and the results support the expectation that in a blended treatment, the strengths of one mode of delivery may compensate for the weaknesses of the other. However, in this certain setting, this is mainly achieved in only one way: F2F sessions compensated for the weaknesses of the web sessions. As a practical conclusion, this may mean that the web sessions, supported by the strengths of the F2F sessions, offer an interesting approach for further improving the blended treatment. Our theoretical findings reflect the relevance of the aspects of hedonism, such as fun, joy, or happiness in the UX, which were not mentioned in relation to the web sessions and were only scarcely mentioned in relation to the F2F sessions. Future research should further investigate the role of hedonistic aspects in a blended treatment and whether increased enjoyment of a blended treatment could increase treatment adherence and, ultimately, effectiveness. %M 32343245 %R 10.2196/14550 %U https://formative.jmir.org/2020/6/e14550 %U https://doi.org/10.2196/14550 %U http://www.ncbi.nlm.nih.gov/pubmed/32343245 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 6 %P e16420 %T A Mobile Health Intervention System for Women With Coronary Heart Disease: Usability Study %A Sengupta,Avijit %A Beckie,Theresa %A Dutta,Kaushik %A Dey,Arup %A Chellappan,Sriram %+ Information Systems and Decision Sciences, University of South Florida, 4202 E Fowler Avenue, Tampa, FL, 33620, United States, 1 8139746338, duttak@usf.edu %K coronary heart disease %K mobile health technology %K behavior change interventions %K women %K mobile phone %D 2020 %7 3.6.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Coronary heart disease (CHD) is the leading cause of death and disability among American women. The prevalence of CHD is expected to increase by more than 40% by 2035. In 2015, the estimated cost of caring for patients with CHD was US $182 billion in the United States; hospitalizations accounted for more than half of the costs. Compared with men, women with CHD or those who have undergone coronary revascularization have up to 30% more rehospitalizations within 30 days and up to 1 year. Center-based cardiac rehabilitation is the gold standard of care after an acute coronary event, but few women attend these valuable programs. Effective home-based interventions for improving cardiovascular health among women with CHD are vital for addressing this gap in care. Objective: The ubiquity of mobile phones has made mobile health (mHealth) behavioral interventions a viable option to improve healthy behaviors of both women and men with CHD. First, this study aimed to examine the usability of a prototypic mHealth intervention designed specifically for women with CHD (herein referred to as HerBeat). Second, we examined the influence of HerBeat on selected health behaviors (self-efficacy for diet, exercise, and managing chronic illness) and psychological (perceived stress and depressive symptoms) characteristics of the participants. Methods: Using a single-group, pretest, posttest design, 10 women participated in the 12-week usability study. Participants were provided a smartphone and a smartwatch on which the HerBeat app was installed. Using a web portal dashboard, a health coach monitored participants’ ecological momentary assessment data, their behavioral data, and their heart rate and step count. Participants then completed a 12-week follow-up assessment. Results: All 10 women (age: mean 64.4 years, SD 6.3 years) completed the study. The usability and acceptability of HerBeat were good, with a mean system usability score of 83.60 (SD 16.3). The participants demonstrated statistically significant improvements in waist circumference (P=.048), weight (P=.02), and BMI (P=.01). Furthermore, depressive symptoms, measured with the Patient Health Questionnaire-9, significantly improved from baseline (P=.04). Conclusions: The mHealth prototype was feasible and usable for women with CHD. Participants provided data that were useful for further development of HerBeat. The mHealth intervention is expected to help women with CHD self-manage their health behaviors. A randomized controlled trial is needed to further verify the findings. %M 32348270 %R 10.2196/16420 %U https://formative.jmir.org/2020/6/e16420 %U https://doi.org/10.2196/16420 %U http://www.ncbi.nlm.nih.gov/pubmed/32348270 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e16137 %T A Patient Safety Educational Tool for Patients With Chronic Kidney Disease: Development and Usability Study %A Bowman,Cassandra %A Lunyera,Joseph %A Alkon,Aviel %A Boulware,L Ebony %A St Clair Russell,Jennifer %A Riley,Jennie %A Fink,Jeffrey C %A Diamantidis,Clarissa %+ Division of General Internal Medicine, Duke University School of Medicine, 200 Morris Street, Durham, NC, 27701, United States, 1 919 668 1261, clarissa.diamantidis@duke.edu %K patient safety %K chronic kidney disease %K patient education %K mhealth %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic kidney disease (CKD) is a health condition that threatens patient safety; however, few interventions provide patient-centered education about kidney-specific safety hazards. Objective: We sought to develop and test the usability of a mobile tablet–based educational tool designed to promote patient awareness of relevant safety topics in CKD. Methods: We used plain language principles to develop content for the educational tool, targeting four patient-actionable safety objectives that are relevant for individuals with CKD. These four objectives included avoidance of nonsteroidal anti-inflammatory drugs (NSAIDs); hypoglycemia awareness (among individuals with diabetes); temporary cessation of certain medications during acute volume depletion to prevent acute kidney injury (ie, “sick day protocol”); and contrast dye risk awareness. Our teaching strategies optimized human-computer interaction and content retention using audio, animation, and clinical vignettes to reinforce themes. For example, using a vignette of a patient with CKD with pain and pictures of common NSAIDs, participants were asked “Which of the following pain medicines are safe for Mr. Smith to take for his belly pain?” Assessment methods consisted of preknowledge and postknowledge surveys, with provision of correct responses and explanations. Usability testing of the tablet-based tool was performed among 12 patients with any stage of CKD, and program tasks were rated upon completion as no error, noncritical error (self-corrected), or critical error (needing assistance). Results: The 12 participants in this usability study were predominantly 65 years of age or older (n=7, 58%) and female (n=7, 58%); all participants owned a mobile device and used it daily. Among the 725 total tasks that the participants completed, there were 31 noncritical errors (4.3%) and 15 critical errors (2.1%); 1 participant accounted for 30 of the total errors. Of the 12 participants, 10 (83%) easily completed 90% or more of their tasks. Most participants rated the use of the tablet as very easy (n=7, 58%), the activity length as “just right” (rather than too long or too short) (n=10, 83%), and the use of clinical vignettes as helpful (n=10, 83%); all participants stated that they would recommend this activity to others. The median rating of the activity was 8 on a scale of 1 to 10 (where 10 is best). We incorporated all participant recommendations into the final version of the educational tool. Conclusions: A tablet-based patient safety educational tool is acceptable and usable by individuals with CKD. Future studies leveraging iterations of this educational tool will explore its impact on health outcomes in this high-risk population. %M 32463366 %R 10.2196/16137 %U http://formative.jmir.org/2020/5/e16137/ %U https://doi.org/10.2196/16137 %U http://www.ncbi.nlm.nih.gov/pubmed/32463366 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e17179 %T Assessing Feasibility of an Early Childhood Intervention Using Mobile Phones Among Low-Income Mothers of Newborns: Qualitative Interview Study %A Zhang,Donglan %A Jin,Lan %A Liang,Di %A Geng,Ruijin %A Liu,Yun %A Ling,Yu %A Jiang,Fan %A Zhang,Yunting %+ Child Health Advocacy Institute, National Children’s Medical Center, Shanghai Children’s Medical Center, 1678 Dongfang Road, Pudong, Shanghai, China, 86 21 3862606, zhangyunting@scmc.com.cn %K mobile health %K interview %K health belief model %K early child development %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Many children aged younger than 5 years living in low- and middle-income countries are at risk for poor development. Early child development (ECD) programs are cost-effective strategies to reduce poverty, crime, school dropouts, and socioeconomic inequality. With the spread of low-cost mobile phones and internet access in low- and middle-income countries, new service delivery models such as mobile phone–aided interventions have a great potential to improve early childhood development. Objective: This study aimed to identify the beliefs on importance of ECD, feasibility of a proposed intervention using mobile phones and factors that may affect the usability of the intervention among mothers of newborns in a poverty-stricken area in southwestern China. Methods: We conducted an in-depth, semistructured interview study of 25 low-income mothers of newborns recruited from two county hospitals in Yunnan Province. We applied the health belief model and cultural competence theories to identify the facilitators, barriers, and preferences among the target population for parenting knowledge. Results: The results showed that the participants had low health literacy and high perceived needs for learning ECD knowledge. At the same time, they experienced several barriers to learning parenting information and following evidence-based instructions including having limited time, limited financial resources, and different opinions on childcare among family members. Many participants preferred to receive personalized messages tailored to their specific needs and preferred videos or graphics to text only in the messages. Many favored a separate module to support postpartum mental health. Conclusions: The study assessed the acceptability of an early childhood intervention using mobile phones to meet the needs of the target population based on their beliefs, traits, and preferences and provided suggestions to refine the intervention to improve its usability. %M 32463374 %R 10.2196/17179 %U http://formative.jmir.org/2020/5/e17179/ %U https://doi.org/10.2196/17179 %U http://www.ncbi.nlm.nih.gov/pubmed/32463374 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15815 %T Reliability, Feasibility, and Patient Acceptance of an Electronic Version of a Multidimensional Health Assessment Questionnaire for Routine Rheumatology Care: Validation and Patient Preference Study %A Pincus,Theodore %A Castrejon,Isabel %A Riad,Mariam %A Obreja,Elena %A Lewis,Candice %A Krogh,Niels Steen %+ Rush University Medical Center, 1611 West Harrison, Suite 510, Chicago, IL, United States, 1 3129428268, tedpincus@gmail.com %K patient reported outcomes %K health status measures %K electronic version %K rapid3 %K mdhaq %D 2020 %7 27.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: A multidimensional health assessment questionnaire (MDHAQ) that was developed primarily for routine rheumatology care has advanced clinical research concerning disease burden, disability, and mortality in rheumatic diseases. Routine Assessment of Patient Index Data 3 (RAPID3), an index within the MDHAQ, is the most widely used index to assess rheumatoid arthritis (RA) in clinical care in the United States, and it recognizes clinical status changes in all studied rheumatic diseases. MDHAQ physical function scores are far more significant in the prognosis of premature RA mortality than laboratory or imaging data. However, electronic medical records (EMRs) generally do not include patient questionnaires. An electronic MDHAQ (eMDHAQ), linked by fast healthcare interoperability resources (FIHR) to an EMR, can facilitate clinical and research advances. Objective: This study analyzed the reliability, feasibility, and patient acceptance of an eMDHAQ. Methods: Since 2006, all Rush University Medical Center rheumatology patients with all diagnoses have been asked to complete a paper MDHAQ at each routine care encounter. In April 2019, patients were invited to complete an eMDHAQ at the conclusion of the encounter. Analyses were conducted to determine the reliability of eMDHAQ versus paper MDHAQ scores, arithmetically and by intraclass correlation coefficient (ICC). The feasibility of the eMDHAQ was analyzed based on the time for patient completion. The patient preference for the electronic or paper version was analyzed through a patient paper questionnaire. Results: The 98 study patients were a typical routine rheumatology patient group. Seven paper versus eMDHAQ scores were within 2%, differences neither clinically nor statistically significant. ICCs of 0.86-0.98 also indicated good to excellent reliability. Mean eMDHAQ completion time was a feasible 8.2 minutes. The eMDHAQ was preferred by 72% of patients; preferences were similar according to age and educational level. Conclusions: The results on a paper MDHAQ versus eMDHAQ were similar. Most patients preferred an eMDHAQ. %M 32459182 %R 10.2196/15815 %U http://formative.jmir.org/2020/5/e15815/ %U https://doi.org/10.2196/15815 %U http://www.ncbi.nlm.nih.gov/pubmed/32459182 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e15158 %T Improving Quality of Care in Rheumatoid Arthritis Through Mobile Patient-Reported Outcome Measurement: Focus Group Study %A Desai,Sonali %A Stevens,Emma %A Emani,Srinivas %A Meyers,Peter %A Iversen,Maura %A Solomon,Daniel H %+ Brigham & Women's Hospital, 60 Fenwood Road, Hale Building for Transformative Medicine, Boston, MA, Rheumatology, 3rd fl, United States, 1 6177326758, sdesai5@bwh.harvard.edu %K quality improvement %K rheumatoid arthritis %D 2020 %7 27.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient-reported outcomes (PROs) for chronic disease management can be integrated into the routine workflow by leveraging mobile technology. Objective: The objective of our study was to describe the process of our quality improvement (QI) efforts using tablets for PRO collection in a busy, academic rheumatology practice to support a treat-to-target (TTT) approach for rheumatoid arthritis (RA) management. Methods: Our QI team designed a process for routine collection of PROs for RA patients at the Arthritis Center, employing information technology and an electronic medical record (EMR) system. Patients received a tablet at the clinic check-in desk to complete the Routine Assessment of Patient Index Data 3 (RAPID3) survey, a validated RA PRO. RAPID3 scores were uploaded to the EMR in real time and available for use in shared decision making during routine office visits. Weekly data were collected on RAPID3 completion rates and shared with front desk staff and medical assistants to drive improvement. Patients in our patient family advisory council and focus groups provided informal feedback on the process. Results: From May 1, 2017, to January 31, 2019, a total of 4233 RAPID3 surveys were completed by 1691 patients. The mean age of patients was 63 (SD 14) years; 84.00% (1420/1691) of the patients were female, and 83.00% (1403/1691) of the patients were white. The rates of RAPID3 completion increased from 14.3% (58/405) in May 2017 to 68.00% (254/376) in September 2017 and were sustained over time through January 2019. Informal feedback from patients was positive and negative, relating to the usability of the tablet and the way rheumatologists used and explained the RAPID3 data in shared decision making during the office visit. Conclusions: We designed a sustainable and reliable process for collecting PROs from patients with RA in the waiting room and integrated these data through the EMR during office visits. %R 10.2196/15158 %U http://formative.jmir.org/2020/3/e15158/ %U https://doi.org/10.2196/15158 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e16202 %T Identifying the Needs for a Web-Based Postpartum Platform Among Parents of Newborns and Health Care Professionals: Qualitative Focus Group Study %A Laureij,Lyzette T %A Breunis,Leonieke J %A Steegers-Theunissen,Regine P M %A Rosman,Ageeth N %+ Department of Health Care Studies, Rotterdam University of Applied Sciences, IVG, RS.06.121, PO Box 25035 Rotterdam, 3001 HR, Rotterdam, 3000 CA, Netherlands, 31 6 425 27 919, a.n.rosman@hr.nl %K newborn %K focus groups %K postpartum period %K postnatal care %K eHealth %K pregnancy %K obstetrics %K qualitative research %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: During the turbulent postpartum period, there is an urgent need by parents for support and information regarding the care for their infant. In the Netherlands, professional support is provided during the first 8 days postpartum and for a maximum of 8 hours a day. This care is delivered by maternity care assistants (MCAs). Despite the availability of this extensive care, a majority of women prefer to make use of a lesser amount of postpartum care. After this period, access to care is less obvious. Where parents are automatically offered care in the first 8 days after birth, they must request care in the period thereafter. To compensate for a possible gap in information transfer, electronic health (eHealth) can be a valuable, easily accessible addition to regular care. Objective: We explored the needs and preferred content by new parents and health care professionals of a web-based platform dedicated to the postpartum period and identified barriers and facilitators for using such a platform. Methods: We conducted 3 semistructured focus groups among (1) parents of newborns, (2) MCAs, and (3) clinicians and administrators in maternity care. A topic list based on a framework designed for innovation processes was used. Thematic content analysis was applied. Results: In the focus group for parents, 5 mothers and 1 male partner participated. A total of 6 MCAs participated in the second focus group. A total of 5 clinicians and 2 administrators—a member of a stakeholder party and a manager of a maternity care organization—participated in the third focus group. All user groups underlined that a platform focusing on the postpartum period was missing in current care, especially by parents experiencing a gap following the intensive care ending after the first week of childbirth. Parents indicated that they would perceive a postpartum platform as a proper source of reliable information on topics regarding breastfeeding, growth, and developmental milestones, but also as a tool to support them in seeking care with appropriate professionals. They also emphasized the need to receive personalized information and the opportunity to ask questions via the platform. MCAs acknowledged added value of providing additional information on topics that they address during the early postpartum period. MCAs as well as clinicians and administrators would guide parents to such a platform for additional support. All user groups experienced disadvantages of using an authentication procedure and filling out extra questionnaires to receive tailored information. Conclusions: Our research shows that parents of newborns, MCAs, and clinicians and administrators foresee the additional value of a web-based postpartum platform for at least the whole postpartum period. The platform should be easily accessible and personalized. Content on the platform should contain information regarding breastfeeding, growth, and developmental milestones. A chat function with professionals could be considered as an option. %M 32452805 %R 10.2196/16202 %U http://formative.jmir.org/2020/5/e16202/ %U https://doi.org/10.2196/16202 %U http://www.ncbi.nlm.nih.gov/pubmed/32452805 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e13170 %T Toward Gamified Pain Management Apps: Mobile Application Rating Scale–Based Quality Assessment of Pain-Mentor’s First Prototype Through an Expert Study %A Hoffmann,Alexandra %A Faust-Christmann,Corinna A %A Zolynski,Gregor %A Bleser,Gabriele %+ Junior Research Group wearHEALTH, Department of Computer Science, Technische Universität Kaiserslautern, Gottlieb-Daimler-Straße 48, Kaiserslautern, 67663, Germany, 49 631 205 3456, hoffmann@cs.uni-kl.de %K mHealth %K chronic pain %K stress management %K pain management %K health app %K gamification %K health professional %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of health apps to support the treatment of chronic pain is gaining importance. Most available pain management apps are still lacking in content quality and quantity as their developers neither involve health experts to ensure target group suitability nor use gamification to engage and motivate the user. To close this gap, we aimed to develop a gamified pain management app, Pain-Mentor. Objective: To determine whether medical professionals would approve of Pain-Mentor’s concept and content, this study aimed to evaluate the quality of the app’s first prototype with experts from the field of chronic pain management and to discover necessary improvements. Methods: A total of 11 health professionals with a background in chronic pain treatment and 2 mobile health experts participated in this study. Each expert first received a detailed presentation of the app. Afterward, they tested Pain-Mentor and then rated its quality using the mobile application rating scale (MARS) in a semistructured interview. Results: The experts found the app to be of excellent general (mean 4.54, SD 0.55) and subjective quality (mean 4.57, SD 0.43). The app-specific section was rated as good (mean 4.38, SD 0.75). Overall, the experts approved of the app’s content, namely, pain and stress management techniques, behavior change techniques, and gamification. They believed that the use of gamification in Pain-Mentor positively influences the patients’ motivation and engagement and thus has the potential to promote the learning of pain management techniques. Moreover, applying the MARS in a semistructured interview provided in-depth insight into the ratings and concrete suggestions for improvement. Conclusions: The experts rated Pain-Mentor to be of excellent quality. It can be concluded that experts perceived the use of gamification in this pain management app in a positive manner. This showed that combining pain management with gamification did not negatively affect the app’s integrity. This study was therefore a promising first step in the development of Pain-Mentor. %M 32452803 %R 10.2196/13170 %U http://formative.jmir.org/2020/5/e13170/ %U https://doi.org/10.2196/13170 %U http://www.ncbi.nlm.nih.gov/pubmed/32452803 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e13388 %T Characteristics of Gamblers Who Use the French National Problem Gambling Helpline and Real-Time Chat Facility: Longitudinal Observational Study %A Darbeda,Stéphane %A Aubin,Henri-Jean %A Lejoyeux,Michel %A Luquiens,Amandine %+ Addiction Science, Paris Sud University, CESP Inserm UMR-1018, 16 Avenue Paul Vaillant Couturier, Villejuif, 94800, France, 33 145595037, stephane.darbeda@gmail.com %K gambling %K helpline %K chat %K counseling %K gender %K time-series analysis %D 2020 %7 20.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Problem gambling is a growing public health issue that is characterized by low rates of face-to-face help seeking. Helplines and real-time chat services could reduce shortfalls in treatment. Objective: This study aimed to (1) describe the characteristics of gamblers contacting a government-funded help service, (2) study the evolution of their characteristics over time, (3) evaluate the differences between subgroups (ie, gender, media used for gambling, and media used to contact the service), and (4) explore factors influencing referral to care. Methods: From January 2011 to December 2015, a government-funded gambling helpline and real-time chat website in France received 9474 contacts from gamblers. Counselors filled in a form for each contact, collecting demographics, gambling characteristics, and referrals. Time-series analyses were performed. Univariate logistic models were used to assess differences across subgroups. A multivariate analysis was conducted to determine the variables related to an actual referral. Results: Gamblers were predominantly men (7017/9474, 74.07%); the average age was 41 years (SD 14). Compared with the men, the women were older (mean 50.7 years, SD 14.0 vs mean 37.9 years, SD 13.0, respectively; P<.001), were more often solely offline gamblers (1922/2457, 78.23% vs 4386/7017, 62.51%, respectively; P<.001), and had different gambling patterns. Compared with helpline contacts, real-time chat contacts were more often men (124/150, 82.7% vs 3643/4881, 74.64%, respectively; P=.04), younger (mean 32.8 years, SD 12.9 vs mean 41.3 years, SD 14.3, respectively; P<.001), more often poker gamblers (41/150, 27.3% vs 592/4881, 12.13%, respectively; P<.001), and more often web-based gamblers (83/150, 55.3% vs 1462/4881, 29.95%, respectively; P<.001). Referral was positively associated with betting (adjusted odds ratio [aOR] 1.46, 95% CI 1.27-1.67; P<.001), casino gambling (aOR 1.38, 95% CI 1.21-1.57; P<.001), scratch cards (aOR 1.83, 95% CI 1.58-2.12; P<.001), poker gambling (aOR 1.35, 95% CI 1.14-1.61; P<.001), lottery (aOR 1.27, 95% CI 1.03-1.56; P=.03), weekly gambling (aOR 1.73, 95% CI 1.40-2.15; P<.001), request for referral (aOR 17.76, 95% CI 14.92-21.13; P<.001), and a history of suicide attempts (aOR 2.13, 95% CI 1.51-3.02; P<.001), and it was negatively associated with web-based gambling (aOR 0.86, 95% CI 0.75-0.98; P=.030) and refusal to be referred (aOR 0.35, 95% CI 0.26-0.49; P<.001). Conclusions: The governmental helpline and chat contacts included a broad range of sociodemographic profiles. Compared with the helpline, real-time chat exchanges reached a younger population of web-based gamblers, which was the target population. The development of the gambling helpline and help online website is a considerable challenge for the future. %M 32432554 %R 10.2196/13388 %U http://formative.jmir.org/2020/5/e13388/ %U https://doi.org/10.2196/13388 %U http://www.ncbi.nlm.nih.gov/pubmed/32432554 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15094 %T Identifying Women at Risk for Polycystic Ovary Syndrome Using a Mobile Health App: Virtual Tool Functionality Assessment %A Rodriguez,Erika Marie %A Thomas,Daniel %A Druet,Anna %A Vlajic-Wheeler,Marija %A Lane,Kevin James %A Mahalingaiah,Shruthi %+ Department of Environmental Health, Harvard TH Chan School of Public Health, 665 Huntington Ave, Building 1, Boston, MA, 02115, United States, 1 617 432 4381, shruthi@hsph.harvard.edu %K polycystic ovary syndrome %K mobile health app %K Clue %K menstrual irregularities %K telemedicine %K mHealth, mobile phone %D 2020 %7 14.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Polycystic ovary syndrome (PCOS) is an endocrine disrupting disorder affecting about 10% of reproductive-aged women. PCOS diagnosis may be delayed several years and may require multiple physicians, resulting in lost time for risk-reducing interventions. Menstrual tracking apps are a potential tool to alert women of their risk while also prompting evaluation from a medical professional. Objective: The primary objective of this study was to develop and pilot test the irregular cycle feature, a predictive model that generated a PCOS risk score, in the menstrual tracking app, Clue. The secondary objectives were to run the model using virtual test subjects, create a quantitative risk score, compare the feature’s risk score with that of a physician, and determine the sensitivity and specificity of the model before empirical testing on human subjects. Methods: A literature review was conducted to generate a list of signs and symptoms of PCOS, termed variables. Variables were then assigned a probability and built into a Bayesian network. Questions were created based on these variables. A total of 9 virtual test subjects were identified using self-reported menstrual cycles and answers to the feature’s questions. Upon completion of the questionnaire, a Result Screen and Doctor’s Report summarizing the probability of having PCOS was displayed. This provided information about PCOS and data to facilitate diagnosis by a medical professional. To assess the accuracy of the feature, the same set of 9 virtual test subjects was assigned probabilities by the feature and the physician, who served as the gold standard. The feature recommended individuals with a score greater than or equal to 25% to follow-up with a physician. Differences between the feature and physician scores were evaluated using a t test and a Pearson correlation coefficient in 8 of the 9 virtual test subjects. A second iteration was conducted to assess the feature’s probability capabilities. Results: The irregular cycle feature’s first iteration produced 1 false-positive compared with the physician score and had an absolute mean difference of 15.5% (SD 15.1%) among the virtual test subjects. The second iteration had 2 false positives compared with the physician score and had an absolute mean difference of 18.8% (SD 13.6%). The feature overpredicted the virtual test subjects’ risk of PCOS compared with the physician. However, a significant positive correlation existed between the feature and physician score (Pearson correlation coefficient=0.82; P=.01). The second iteration performed worse, with a Pearson correlation coefficient of 0.73 (P=.03). Conclusions: The first iteration of the feature outperformed the second and better predicted the probability of PCOS. Although further research is needed with a more robust sample size, this pilot study indicates the potential value for developing a screening tool to prompt high-risk subjects to seek evaluation by a medical professional. %M 32406861 %R 10.2196/15094 %U https://formative.jmir.org/2020/5/e15094 %U https://doi.org/10.2196/15094 %U http://www.ncbi.nlm.nih.gov/pubmed/32406861 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e16297 %T Using the Preparation Phase of the Multiphase Optimization Strategy to Develop a Messaging Component for Weight Loss: Formative and Pilot Research %A Pfammatter,Angela Fidler %A Marchese,Sara Hoffman %A Pellegrini,Christine %A Daly,Elyse %A Davidson,Miriam %A Spring,Bonnie %+ Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1400, Chicago, IL, 60611, United States, 1 312 503 1574, angela@northwestern.edu %K weight loss %K body weight %K text messaging %K optimization %K automation %D 2020 %7 13.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile messaging is often used in behavioral weight loss interventions, yet little is known as to the extent to which they contribute to weight loss when part of a multicomponent treatment package. The multiphase optimization strategy (MOST) is a framework that researchers can use to systematically investigate interventions that achieve desirable outcomes given specified constraints. Objective: This study describes the use of MOST to develop a messaging intervention as a component to test as part of a weight loss treatment package in a subsequent optimization trial. Methods: On the basis of our conceptual model, a text message intervention was created to support self-regulation of weight-related behaviors. We tested the messages in the ENLIGHTEN feasibility pilot study. Adults with overweight and obesity were recruited to participate in an 8-week weight loss program. Participants received a commercially available self-monitoring smartphone app, coaching calls, and text messages. The number and frequency of text messages sent were determined by individual preferences, and weight was assessed at 8 weeks. Results: Participants (n=9) in the feasibility pilot study lost 3.2% of their initial body weight over the 8-week intervention and preferred to receive 1.8 texts per day for 4.3 days per week. Researcher burden in manually sending messages was high, and the cost of receiving text messages was a concern. Therefore, a fully automated push notification system was developed to facilitate sending tailored daily messages to participants to support weight loss. Conclusions: Following the completion of specifying the conceptual model and the feasibility pilot study, the message intervention went through a final iteration. Theory and feasibility pilot study results during the preparation phase informed critical decisions about automation, frequency, triggers, and content before inclusion as a treatment component in a factorial optimization trial. Trial Registration: ClinicalTrials.gov NCT01814072; https://clinicaltrials.gov/ct2/show/NCT01814072 %M 32347804 %R 10.2196/16297 %U http://formative.jmir.org/2020/5/e16297/ %U https://doi.org/10.2196/16297 %U http://www.ncbi.nlm.nih.gov/pubmed/32347804 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 5 %P e15888 %T A Sexual Health Promotion App for Transgender Women (Trans Women Connected): Development and Usability Study %A Sun,Christina J %A Anderson,Kirsten M %A Kuhn,Tamara %A Mayer,Liat %A Klein,Charles H %+ School of Public Health, Oregon Health & Science University-Portland State University, 506 SW Mill St., Suite 450, SCH, Portland, OR, 97201, United States, 1 503 725 8858, chrsun@pdx.edu %K transgender persons %K HIV %K sexual health %K minority health %K health care disparities %K health status disparities %D 2020 %7 12.5.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: HIV severely impacts the transgender communities in the United States, and transgender women have the highest HIV incidence rates among any identified risk group. Guided by formative research with transgender women and by an expert advisory panel of transgender women, we designed a prototype mobile app to promote HIV prevention among transgender women. Objective: This study aimed to develop and test the usability and acceptability of the prototype Trans Women Connected mobile app. Methods: We engaged in a 3-phase prototype development process. After conducting formative research about the health needs of this population, we outlined a theory-based app framework and developed three prototype activities (ie, a vision board, a pre-exposure prophylaxis [PrEP] education activity, and an interactive map). We then tested the usability and acceptability of the mobile app and activities with 16 transgender women using pre- and posttests, think-aloud protocols, and open-ended questions. Results: Participants reported high acceptability for the mobile app; the mean rating across all usability and likability questions was 5.9 out of 7. Service utilization intention, goal setting, and social support increased at posttest compared with pretest. Increases in self-efficacy in finding lesbian, gay, bisexual, transgender, and queer–friendly services; intention to seek online social support; and PrEP knowledge were statistically significant. Participants described the app as attractive and useful and perceived all three activities positively. Conclusions: This study describes the development and usability and acceptability evaluation of a prototype mobile app designed for and with transgender women for HIV prevention. The usability testing findings provided important insights toward refining and the further development of the Trans Women Connected mobile app. The results suggest that a mobile health intervention can support positive changes. The remaining development and efficacy randomized trial of the Trans Women Connected mobile app is currently underway. %M 32396131 %R 10.2196/15888 %U https://mhealth.jmir.org/2020/5/e15888 %U https://doi.org/10.2196/15888 %U http://www.ncbi.nlm.nih.gov/pubmed/32396131 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 2 %P e16605 %T A Cyber-Physical System for Near Real-Time Monitoring of At-Home Orthopedic Rehabilitation and Mobile–Based Provider-Patient Communications to Improve Adherence: Development and Formative Evaluation %A Stevens,Timothy %A McGinnis,Ryan S %A Hewgill,Blake %A Choquette,Rebecca H %A Tourville,Timothy W %A Harvey,Jean %A Lachapelle,Richard %A Beynnon,Bruce D %A Toth,Michael J %A Skalka,Christian %+ Department of Medicine, University of Vermont, Health Science Research Facility Rm 126B, 149 Beaumont Ave, Burlington, VT, 05405, United States, 1 (802) 656 7989, michael.toth@med.uvm.edu %K device use tracking %K internet of things %K neuromuscular electrical stimulation %K exercise %K smart devices %K mHealth %K rehabilitation %K mobile health %K digital health %D 2020 %7 11.5.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Knee extensor muscle performance is reduced after lower extremity trauma and orthopedic surgical interventions. At-home use of neuromuscular electrical stimulation (NMES) may improve functional recovery, but adherence to at-home interventions is low. Greater benefits from NMES may be realized with closer monitoring of adherence to at-home prescriptions and more frequent patient-provider interactions. Objective: This study aimed to develop a cyber-physical system to monitor at-home adherence to NMES prescription and facilitate patient-provider communications to improve adherence in near real time. Methods: The RehabTracker cyber-physical system was developed to accomplish this goal and comprises four components: (1) hardware modifications to a commercially available NMES therapy device to monitor device use and provide Bluetooth functionality; (2) an iPhone Operating System–based mobile health (mHealth) app that enables patient-provider communications in near real time; (3) a clinician portal to allow oversight of patient adherence with device use; and (4) a back-end server to store data, enable adherence analysis, and send automated push notifications to the patient. These four elements were designed to be fully compliant with the Health Insurance Portability and Accountability Act. The system underwent formative testing in a cohort of patients following anterior cruciate ligament rupture (n=7) to begin to assess face validity. Results: Compared with the NMES device software–tracked device use, the RehabTracker system recorded 83% (40/48) of the rehabilitation sessions, with 100% (32/32) of all sessions logged by the system in 4 out of 7 patients. In patients for whom tracking of automated push notifications was enabled, 100% (29/29) of the push notifications sent by the back-end server were received by the patient. Process, hardware, and software issues contributing to these inaccuracies are detailed. Conclusions: RehabTracker represents a promising mHealth app for tracking and improving adherence with at-home NMES rehabilitation programs and warrants further refinement and testing. %M 32384052 %R 10.2196/16605 %U http://humanfactors.jmir.org/2020/2/e16605/ %U https://doi.org/10.2196/16605 %U http://www.ncbi.nlm.nih.gov/pubmed/32384052 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15568 %T Mental Health Therapy Protocols and eHealth Design: Focus Group Study %A van Dooren,Marierose M M %A Visch,Valentijn %A Spijkerman,Renske %A Goossens,Richard H M %A Hendriks,Vincent M %+ Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 15 27 87660, m.m.m.vandooren@tudelft.nl %K eHealth design %K mental health care %K personalization %K protocol %K youth addiction care %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic health (eHealth) programs are often based on protocols developed for the original face-to-face therapies. However, in practice, therapists and patients may not always follow the original therapy protocols. This form of personalization may also interfere with the intended implementation and effects of eHealth interventions if designers do not take these practices into account. Objective: The aim of this explorative study was to gain insights into the personalization practices of therapists and patients using cognitive behavioral therapy, one of the most commonly applied types of psychotherapy, in a youth addiction care center as a case context. Methods: Focus group discussions were conducted asking therapists and patients to estimate the extent to which a therapy protocol was followed and about the type and reasons for personalization of a given therapy protocol. A total of 7 focus group sessions were organized involving therapists and patients. We used a commonly applied protocol for cognitive behavioral therapy as a therapy protocol example in youth mental health care. The first focus group discussions aimed at assessing the extent to which patients (N=5) or therapists (N=6) adapted the protocol. The second focus group discussions aimed at estimating the extent to which the therapy protocol is applied and personalized based on findings from the first focus groups to gain further qualitative insight into the reasons for personalization with groups of therapists and patients together (N=7). Qualitative data were analyzed using thematic analysis. Results: Therapists used the protocol as a “toolbox” comprising different therapy tools, and personalized the protocol to enhance the therapeutic alliance and based on their therapy-provision experiences. Therapists estimated that they strictly follow 48% of the protocol, adapt 30%, and replace 22% by other nonprotocol therapeutic components. Patients personalized their own therapy to conform the assignments to their daily lives and routines, and to reduce their levels of stress and worry. Patients estimated that 29% of the provided therapy had been strictly followed by the therapist, 48% had been adjusted, and 23% had been replaced by other nonprotocol therapeutic components. Conclusions: A standard cognitive behavioral therapy protocol is not strictly and fully applied but is mainly personalized. Based on these results, the following recommendations for eHealth designers are proposed to enhance alignment of eHealth to therapeutic practice and implementation: (1) study and copy at least the applied parts of a protocol, (2) co-design eHealth with therapists and patients so they can allocate the components that should be open for user customization, and (3) investigate if components of the therapy protocol that are not applied should remain part of the eHealth applied. To best generate this information, we suggest that eHealth designers should collaborate with therapists, patients, protocol developers, and mental health care managers during the development process. %M 32374271 %R 10.2196/15568 %U https://formative.jmir.org/2020/5/e15568 %U https://doi.org/10.2196/15568 %U http://www.ncbi.nlm.nih.gov/pubmed/32374271 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e14064 %T Privacy-Preserving Deep Learning for the Detection of Protected Health Information in Real-World Data: Comparative Evaluation %A Festag,Sven %A Spreckelsen,Cord %+ Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Bachstraße 18, Jena, , Germany, 49 3641 9 398360, Cord.Spreckelsen@med.uni-jena.de %K privacy-preserving protocols %K neural networks %K health informatics %K distributed machine learning %D 2020 %7 5.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Collaborative privacy-preserving training methods allow for the integration of locally stored private data sets into machine learning approaches while ensuring confidentiality and nondisclosure. Objective: In this work we assess the performance of a state-of-the-art neural network approach for the detection of protected health information in texts trained in a collaborative privacy-preserving way. Methods: The training adopts distributed selective stochastic gradient descent (ie, it works by exchanging local learning results achieved on private data sets). Five networks were trained on separated real-world clinical data sets by using the privacy-protecting protocol. In total, the data sets contain 1304 real longitudinal patient records for 296 patients. Results: These networks reached a mean F1 value of 0.955. The gold standard centralized training that is based on the union of all sets and does not take data security into consideration reaches a final value of 0.962. Conclusions: Using real-world clinical data, our study shows that detection of protected health information can be secured by collaborative privacy-preserving training. In general, the approach shows the feasibility of deep learning on distributed and confidential clinical data while ensuring data protection. %M 32369025 %R 10.2196/14064 %U https://formative.jmir.org/2020/5/e14064 %U https://doi.org/10.2196/14064 %U http://www.ncbi.nlm.nih.gov/pubmed/32369025 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15083 %T A Persuasive mHealth Behavioral Change Intervention for Promoting Physical Activity in the Workplace: Feasibility Randomized Controlled Trial %A Haque,Md Sanaul %A Kangas,Maarit %A Jämsä,Timo %+ Research Unit of Medical Imaging Physics and Technology, Faculty of Medicine, University of Oulu, PO Box 5000, Oulu, 90014, Finland, 358 469557272, md.haque@oulu.fi %K mHealth behavioral change intervention %K persuasive app %K UCD %K game elements %K physical activity %K SDT %D 2020 %7 4.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Employees in an office setting are more likely to remain physically inactive. Physical inactivity has become one of the major barriers to overcoming the risk factors for anxiety, depression, coronary heart disease, certain cancers, and type 2 diabetes. Currently, there is a gap in mobile health (mHealth) apps to promote physical activity (PA) for workers in the workplace. Studies on behavior change theories have concluded that health apps generally lack the use of theoretical constructs. Objective: The objective of this study was to study the feasibility of a persuasive app aimed at encouraging PA among employees and to understand the motivational aspects behind the implementation of mHealth apps among office workers. Methods: A 4-week study using a mixed methods (quantitative and qualitative) design was conducted with office-based employees in cities in 4 countries: Oulu, Finland; Carlow, Ireland; London, United Kingdom; and Dhaka, Bangladesh. Of the 220 invited participants (experimental group, n=115; control group, n=105), 84 participated (experimental group, n=56; control group, n=28), consisting of working-age volunteers working in an office setting. Participants used 2 different interventions: The experimental group used an mHealth app for PA motivation, and the control group used a paper diary. The purpose was to motivate employees to engage in healthier behavior regarding the promotion of PA in the workplace. A user-centered design process was followed to design, develop, and evaluate the mHealth app, incorporating self-determination theory (SDT) and using game elements. The paper diary had no specific theory-driven approach, design technique, nor game elements. Results: Compliance with app usage remained relatively low, with 27 participants (experimental group, n=20; control group, n=7) completing the study. The results support the original hypothesis that the mHealth app would help increase PA (ie, promoting daily walking in the workplace) in comparison to a paper diary (P=.033). The mHealth app supported 2 of the basic SDT psychological needs, namely autonomy (P=.004) and competence (P=.014), but not the needs of relatedness (P=.535). Conclusions: The SDT-based mHealth application motivated employees to increase their PA in the workplace. However, compliance with app usage remained low. Future research should further develop the app based on user feedback and test it in a larger sample. %M 32364506 %R 10.2196/15083 %U https://formative.jmir.org/2020/5/e15083 %U https://doi.org/10.2196/15083 %U http://www.ncbi.nlm.nih.gov/pubmed/32364506 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e13746 %T An Electronic Medication Module to Improve Health Literacy in Patients With Type 2 Diabetes Mellitus: Pilot Randomized Controlled Trial %A Seidling,Hanna Marita %A Mahler,Cornelia %A Strauß,Beate %A Weis,Aline %A Stützle,Marion %A Krisam,Johannes %A , %A Szecsenyi,Joachim %A Haefeli,Walter Emil %+ Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, 69120, Germany, 49 6221 56 8740, walter.emil.haefeli@med.uni-heidelberg.de %K medication self-management %K patient empowerment %K health literacy %K chronic diseases %K type 2 diabetes mellitus %K electronic health record %K PEPA %K electronic medication module %K structured medication review %D 2020 %7 28.4.2020 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 32343246 %R 10.2196/13746 %U http://formative.jmir.org/2020/4/e13746/ %U https://doi.org/10.2196/13746 %U http://www.ncbi.nlm.nih.gov/pubmed/32343246 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e13188 %T Developing an Intranet-Based Lymphedema Dashboard for Breast Cancer Multidisciplinary Teams: Design Research Study %A Janssen,Anna %A Donnelly,Candice %A Kay,Judy %A Thiem,Peter %A Saavedra,Aldo %A Pathmanathan,Nirmala %A Elder,Elisabeth %A Dinh,Phuong %A Kabir,Masrura %A Jackson,Kirsten %A Harnett,Paul %A Shaw,Tim %+ Research in Implementation Science and eHealth Group, Faculty of Health Sciences, The University of Sydney, Charles Perkins Centre (D17), Sydney, 2006, Australia, 61 9036 9406, anna.janssen@sydney.edu.au %K eHealth %K clinical informatics %K human-centered design %K data visualization %D 2020 %7 21.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: A large quantity of data is collected during the delivery of cancer care. However, once collected, these data are difficult for health professionals to access to support clinical decision making and performance review. There is a need for innovative tools that make clinical data more accessible to support health professionals in these activities. One approach for providing health professionals with access to clinical data is to create the infrastructure and interface for a clinical dashboard to make data accessible in a timely and relevant manner. Objective: This study aimed to develop and evaluate 2 prototype dashboards for displaying data on the identification and management of lymphedema. Methods: The study used a co-design framework to develop 2 prototype dashboards for use by health professionals delivering breast cancer care. The key feature of these dashboards was an approach for visualizing lymphedema patient cohort and individual patient data. This project began with 2 focus group sessions conducted with members of a breast cancer multidisciplinary team (n=33) and a breast cancer consumer (n=1) to establish clinically relevant and appropriate data for presentation and the visualization requirements for a dashboard. A series of fortnightly meetings over 6 months with an Advisory Committee (n=10) occurred to inform and refine the development of a static mock-up dashboard. This mock-up was then presented to representatives of the multidisciplinary team (n=3) to get preliminary feedback about the design and use of such dashboards. Feedback from these presentations was reviewed and used to inform the development of the interactive prototypes. A structured evaluation was conducted on the prototypes, using Think Aloud Protocol and semistructured interviews with representatives of the multidisciplinary team (n=5). Results: Lymphedema was selected as a clinically relevant area for the prototype dashboards. A qualitative evaluation is reported for 5 health professionals. These participants were selected from 3 specialties: surgery (n=1), radiation oncology (n=2), and occupational therapy (n=2). Participants were able to complete the majority of tasks on the dashboard. Semistructured interview themes were categorized into engagement or enthusiasm for the dashboard, user experience, and data quality and completeness. Conclusions: Findings from this study constitute the first report of a co-design process for creating a lymphedema dashboard for breast cancer health professionals. Health professionals are interested in the use of data visualization tools to make routinely collected clinical data more accessible. To be used effectively, dashboards need to be reliable and sourced from accurate and comprehensive data sets. While the co-design process used to develop the visualization tool proved effective for designing an individual patient dashboard, the complexity and accessibility of the data required for a cohort dashboard remained a challenge. %M 32314968 %R 10.2196/13188 %U https://www.jmir.org/2020/4/e13188 %U https://doi.org/10.2196/13188 %U http://www.ncbi.nlm.nih.gov/pubmed/32314968 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e12098 %T Using Crowdsourcing to Develop a Peer-Led Intervention for Safer Dating App Use: Pilot Study %A Wong,William Chi Wai %A Song,Lin %A See,Christopher %A Lau,Stephanie Tze Hei %A Sun,Wai Han %A Choi,Kitty Wai Ying %A Tucker,Joseph %+ Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, 2/F, Ap Lei Chau Clinic, 161 Ap Lei Chau Main Street, Ap Lei Chau, Hong Kong, 852 67456763, songlinhk@gmail.com %K dating apps %K intervention mapping %K crowdsourcing %K peer-led approach %K sexual health %D 2020 %7 21.4.2020 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 32314975 %R 10.2196/12098 %U http://formative.jmir.org/2020/4/e12098/ %U https://doi.org/10.2196/12098 %U http://www.ncbi.nlm.nih.gov/pubmed/32314975 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e15534 %T Optimizing Child Nutrition Education With the Foodbot Factory Mobile Health App: Formative Evaluation and Analysis %A Brown,Jacqueline Marie %A Savaglio,Robert %A Watson,Graham %A Kaplansky,Allison %A LeSage,Ann %A Hughes,Janette %A Kapralos,Bill %A Arcand,JoAnne %+ Faculty of Health Sciences, University of Ontario Institute of Technology, 2000 Simcoe Street North, Science Building Rm 3016, Oshawa, ON, L1G 0C5, Canada, 1 (905) 7218668 ext 3796, joanne.arcand@uoit.ca %K mHealth %K children %K child nutrition sciences %K mobile apps %K health education %D 2020 %7 17.4.2020 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 32301743 %R 10.2196/15534 %U http://formative.jmir.org/2020/4/e15534/ %U https://doi.org/10.2196/15534 %U http://www.ncbi.nlm.nih.gov/pubmed/32301743 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e16151 %T 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 %A Nicklas,Jacinda M %A Leiferman,Jenn A %A Lockhart,Steven %A Daly,Kristen M %A Bull,Sheana S %A Barbour,Linda A %+ Division of General Internal Medicine, University of Colorado School of Medicine, 12348 E Montview Blvd, Aurora, CO, 80045, United States, 1 3037249028, Jacinda.Nicklas@cuanschutz.edu %K mobile health %K postpartum %K chronic disease %K prevention %K weight loss %D 2020 %7 9.4.2020 %9 Original Paper %J JMIR Form Res %G English %X 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 %M 32271149 %R 10.2196/16151 %U https://formative.jmir.org/2020/4/e16151 %U https://doi.org/10.2196/16151 %U http://www.ncbi.nlm.nih.gov/pubmed/32271149 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e17901 %T A Mobile Sexual Health App on Empowerment, Education, and Prevention for Young Adult Men (MyPEEPS Mobile): Acceptability and Usability Evaluation %A Gannon,Brittany %A Davis,Rindcy %A Kuhns,Lisa M %A Rodriguez,Rafael Garibay %A Garofalo,Robert %A Schnall,Rebecca %+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K young adults %K usability %K HIV %K mHealth %K young men %K mobile phone %D 2020 %7 7.4.2020 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 32254043 %R 10.2196/17901 %U https://formative.jmir.org/2020/4/e17901 %U https://doi.org/10.2196/17901 %U http://www.ncbi.nlm.nih.gov/pubmed/32254043 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 4 %P e14504 %T Evaluation of an Educational Health Website on Infections and Antibiotics in England: Mixed Methods, User-Centered Approach %A Allison,Rosalie %A Hayes,Catherine %A Young,Vicki %A McNulty,Cliodna A M %+ Public Health England, Twyver House, Gloucester, GL1 1DQ, United Kingdom, 44 208 495 3258, rosie.allison@phe.gov.uk %K user experience %K usability %K quality %K online %K science %K health %D 2020 %7 6.4.2020 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 32203932 %R 10.2196/14504 %U https://formative.jmir.org/2020/4/e14504 %U https://doi.org/10.2196/14504 %U http://www.ncbi.nlm.nih.gov/pubmed/32203932 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e15494 %T Mutual-Aid Mobile App for Emergency Care: Feasibility Study %A Chien,Shuo-Chen %A Islam,Md Mohaimenul %A Yeh,Chen-An %A Chien,Po-Han %A Chen,Chun You %A Chin,Yen-Po %A Lin,Ming-Chin %+ Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, 15F, No 172-1, Sec 2, Keelung Rd, Da’an District, Taipei, Taiwan, 886 2 6638 2736 ext 3351, arbiter@tmu.edu.tw %K technology acceptance model %K cardiopulmonary resuscitation %K mobile app %K emergency care %D 2020 %7 19.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Improving the quality of patient care through the use of mobile devices is one of the hot topics in the health care field. In unwanted situations like an accident, ambulances and rescuers often require a certain amount of time to arrive at the scene. Providing immediate cardiopulmonary resuscitation (CPR) to patients might improve survival. Objective: The primary objective of this study was to evaluate the feasibility of an emergency and mutual-aid app model in Taiwan and to provide a reference for government policy. Methods: A structured questionnaire was developed as a research tool. All questionnaires were designed according to the technology acceptance model, and a Likert scale was used to measure the degree of agreement or disagreement. Moreover, in-depth interviews were conducted with six experts from medical, legal, and mobile app departments. Each expert was interviewed once to discuss feasible countermeasures and suggestions. Statistical Package for the Social Sciences (SPSS version 19; IBM Corp, Armonk, New York) was used to perform all statistical analyses, including descriptive statistics, independent sample t-tests, variance analysis, and Pearson correlation analysis. Results: We conducted this study between October 20, 2017, and November 10, 2017, at the Taipei Medical University Hospital. Questionnaires were distributed to medical personnel, visiting guests, family members, and volunteers. A total of 113 valid questionnaires were finally obtained after the exclusion of incomplete questionnaires. Cronbach α values for self-efficacy (perceived ease of use), use attitude (perceived usefulness), and use willingness and frequency were above .85, meeting the criterion of greater than .70. We observed that the reliability of each subquestion was acceptable and the values for use attitude (perceive usefulness) and use willingness and frequency were more than .90. Conclusions: The findings suggest that perceived ease of use and perceived usefulness of the app model affect use willingness. However, perceived usefulness had an intermediary influence on use willingness. Experts in law, medical, and technology fields consider that an emergency and mutual-aid model can be implemented in Taiwan. Along with the development of an emergency and mutual-aid app model, we recommend an increase in the number of automated external defibrillators per region and promotion of correct knowledge about CPR in order to decrease morbidity and mortality. %M 32191212 %R 10.2196/15494 %U https://formative.jmir.org/2020/3/e15494 %U https://doi.org/10.2196/15494 %U http://www.ncbi.nlm.nih.gov/pubmed/32191212 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e13900 %T A Walking Intervention Supplemented With Mobile Health Technology in Low-Active Urban African American Women With Asthma: Proof-of-Concept Study %A Nyenhuis,Sharmilee M %A Balbim,Guilherme Moraes %A Ma,Jun %A Marquez,David X %A Wilbur,JoEllen %A Sharp,Lisa K %A Kitsiou,Spyros %+ Department of Medicine, University of Illinois at Chicago, 840 S Wood St, MC 719, Chicago, IL, 60612, United States, 1 312 413 1655, snyenhui@uic.edu %K activity trackers %K text message %K physical activity %K asthma %K African-American %K women %K mHealth %K smartphone %K mobile phone %D 2020 %7 11.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Physical inactivity is associated with worse asthma outcomes. African American women experience disparities in both physical inactivity and asthma relative to their white counterparts. We conducted a modified evidence-based walking intervention supplemented with mobile health (mHealth) technologies to increase physical activity (PA). Objective: This study aimed to assess the preliminary feasibility of a 7-week walking intervention modified for African American women with asthma. Methods: African American women with suboptimally controlled asthma were identified from a health system serving low-income minorities. At a baseline data collection visit, participants performed spirometry and incremental shuttle walk test, completed questionnaires, and were given an accelerometer to wear for 1 week. The intervention comprised an informational study manual and 3 in-person group sessions over 7 weeks, led by a nurse interventionist, in a community setting. The supplemental mHealth tools included a wearable activity tracker device (Fitbit Charge HR) and one-way text messages related to PA and asthma 3 times per week. A secure Web-based research platform, iCardia, was used to obtain Fitbit data in real time (wear time, moderate-to-vigorous physical activity [MVPA] and sedentary time) and send text messages. The feasibility of the intervention was assessed in the domains of recruitment capability, acceptability (adherence, retention, engagement, text messaging, acceptability, complaints, and concerns), and preliminary outcome effects on PA behavior (change in steps, duration, and intensity). Results: We approached 22 women, of whom 10 were eligible; 7 consented, enrolled and completed the study. Group session attendance was 71% (5/7), 86% (6/7), and 86% (6/7), respectively, across the 3 sessions. All participants completed evaluations at each group session. The women reported being satisfied or very satisfied with the program (eg, location, time, and materials). None of them had concerns about using, charging, or syncing the Fitbit device and app. Participants wore their Fitbit device for at least 10 hours per day in 44 out of the 49 intervention days. There was an increase in Fitbit-measured MVPA from week 1 (19 min/week, SD 14 min/week) to the last week of intervention (22 min/week, SD 12 min/week; Cohen d=0.24, 95% CI 0.1 to 6.4). A slight decrease in step count was observed from week 1 (8926 steps/day, SD 2156 steps/day) to the last week of intervention (8517 steps/day, SD 1612 steps/day; Cohen d=−0.21, 95% CI −876.9 to 58.9). Conclusions: The initial feasibility results of a 7-week community-based walking intervention tailored for African American women with asthma and supplemented with mHealth tools are promising. Modifications to recruitment, retention, and the intervention itself are needed. These findings support the need to conduct a further modified pilot trial to collect additional data on feasibility and estimate the efficacy of the intervention on asthma and PA outcomes. %M 32159520 %R 10.2196/13900 %U https://formative.jmir.org/2020/3/e13900 %U https://doi.org/10.2196/13900 %U http://www.ncbi.nlm.nih.gov/pubmed/32159520 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e14652 %T Developing SMS Content to Promote Papanicolaou Triage Among Women Who Performed HPV Self-collection Test: Qualitative Study %A Sanchez Antelo,Victoria %A Kohler,Racquel E %A Curotto,Mariana %A Viswanath,Kasisomayajula "Vish" %A Paolino,Melisa %A Arrossi,Silvina %+ Centro de Estudios de Estado y Sociedad, Sánchez de Bustamante, 27, C1173AAA, Buenos Aires, Argentina, 54 1148651707, silviarrossi2020@gmail.com %K text messaging %K cell phone use %K telemedicine %K human papillomavirus DNA tests %K triage %K health behavior %K Argentina %D 2020 %7 6.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: SMS interventions are effective in promoting a variety of health behaviors; however, there is limited information regarding the use of SMS for cervical cancer screening and follow-up care. The Application of Communication and Information Technologies to Self-Collection study aims to evaluate a multicomponent mobile health intervention to increase triage adherence among women with human papillomavirus (HPV)–positive self-collected tests in Jujuy, Argentina. Here, we describe the formative results used to design the content of the SMS to be tested in the trial. Objective: This study aimed to understand the cultural and contextual elements, women’s beliefs, and perceptions regarding the use of SMS by the health care system and women’s preferences about the message content. Methods: We conducted five focus groups (FGs), stratified by rural or urban residence and age. All participants were aged 30 years or older and had performed HPV self-collection. Participatory techniques, including brainstorming, card-based classification, and discussions were used to debate the advantages and disadvantages of messages. We openly coded the discussions for agreements and preferences regarding the SMS content. Messages for both HPV-negative and HPV-positive women were validated through interviews with health authorities and 14 HPV-tested women. The final versions of the messages were pilot-tested. Results: A total of 48 women participated in the FGs. Participants rejected receiving both negative and positive HPV results by SMS because, for them, the delivery of results should be done in a face-to-face interaction with health professionals. They stressed the importance of the SMS content informing them that results were available for pick up and reflecting the kind of relationship that they have with the community health workers and the nearest health center. Women considered that a personalized SMS was important, as was the use of a formal yet warm tone. Owing to confidentiality issues, not using the word “HPV” was also a key component of the desired SMS content; therefore, the final message included the term “self-collection” without the mention of HPV infection. Results from the validation stage and pilot test showed high acceptability of the final version of the message. Conclusions: The results suggest that SMS is accepted when notifying women about the availability of the HPV test result, but it should not replace the delivery of results in face-to-face, doctor-patient encounters. In addition, messages must be tailored and must have a persuasive tone to motivate women to adhere to the triage. %M 32032940 %R 10.2196/14652 %U https://formative.jmir.org/2020/3/e14652 %U https://doi.org/10.2196/14652 %U http://www.ncbi.nlm.nih.gov/pubmed/32032940 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e15962 %T Understanding Students’ Mental Well-Being Challenges on a University Campus: Interview Study %A Park,Sun Young %A Andalibi,Nazanin %A Zou,Yikai %A Ambulkar,Siddhant %A Huh-Yoo,Jina %+ School of Information, University of Michigan, Ann Arbor, MI, United States, 1 9360671, sunypark@umich.edu %K emerging adults %K university students %K life events %K mental wellbeing %K mental wellness %K mental health %K social support %D 2020 %7 5.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Research shows that emerging adults face numerous stressors as they transition from adolescence to adulthood. This paper investigates university students’ lived experiences of maintaining mental well-being during major life events and challenges associated with this transitional period. As we continue to design health technology to support students’ mental health needs, it is imperative to understand the fundamental needs and issues particular to this phase of their life to effectively engage and lower the barriers to seeking help. Objective: This study first aimed to understand how university students currently seek and receive support to maintain their mental well-being while going through frequent life events during this period of emerging adulthood. The study then aimed to provide design requirements for how social and technical systems should support the students’ mental well-being maintenance practice. Methods: Semistructured interviews with 19 students, including graduate and undergraduate students, were conducted at a large university in the Midwest in the United States. Results: This study’s findings identified three key needs: students (1) need to receive help that aligns with the perceived severity of the problem caused by a life event, (2) have to continuously rebuild relationships with support givers because of frequent life events, and (3) negotiate tensions between the need to disclose and the stigma associated with disclosure. The study also identified three key factors related to maintaining mental well-being: time, audience, and disclosure. Conclusions: On the basis of this study’s empirical findings, we discuss how and when help should be delivered through technology to better address university students’ needs for maintaining their mental well-being, and we argue for reconceptualizing seeking and receiving help as a colearning process. %M 32134393 %R 10.2196/15962 %U http://formative.jmir.org/2020/3/e15962/ %U https://doi.org/10.2196/15962 %U http://www.ncbi.nlm.nih.gov/pubmed/32134393 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e17060 %T Patients’ Attitudes Toward an Online Patient Portal for Communicating Laboratory Test Results: Real-World Study Using the eHealth Impact Questionnaire %A Talboom-Kamp,Esther %A Tossaint-Schoenmakers,Rosian %A Goedhart,Annelijn %A Versluis,Anke %A Kasteleyn,Marise %+ Saltro Diagnostic Centre, Mississippidreef 83, Utrecht, 3565 CE, Netherlands, 31 30 2361170, e.talboom@saltro.nl %K patient portals %K eHealth Impact Questionnaire %K eHIQ %K laboratory test results %K attitude to health %K self efficacy %K telemedicine %K usability %D 2020 %7 4.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Communicating laboratory test results online has several advantages for patients, such as improving clinical efficiency and accessibility, thereby helping patients to take an active role in managing their health. Objective: This study aimed to investigate the experiences and self-efficacy of patients using an online patient portal that communicates laboratory test results. Methods: We used the online-administered eHealth Impact Questionnaire to explore patients’ attitudes toward the portal. Patients visiting the portal were asked to complete the questionnaire. The subscale Information and Presentation assessed the usability of the patient portal and the subscale Motivation and Confidence to Act assessed self-efficacy to determine whether patients were motivated to act on the presented information. We used a cutoff score of 65 or greater to determine whether the portal was rated positively. Results: The questionnaire was completed by 354 of 13,907 patients who viewed their laboratory results in the patient portal, with a response rate of 2.55%. The mean Information and Presentation score was 67.70 (SD 13.12) and the mean Motivation and Confidence to Act score was 63.59 (SD 16.22). We found a positive, significant correlation between the 2 subscales (r345=.77, P<.001). Conclusions: Patients participating in the study rated the usability of the portal positively. However, the portal only slightly helped patients to take an active role in managing their own health. The low response rate precludes generalization of the results. Future research should examine avenues to further increase patients’ self-efficacy and study whether portal acceptability differs in subgroups. Patient portals conveying laboratory test results in understandable language seem usable and potentially provide a viable way to help patients take a more active role in managing their own health. %M 32024632 %R 10.2196/17060 %U https://formative.jmir.org/2020/3/e17060 %U https://doi.org/10.2196/17060 %U http://www.ncbi.nlm.nih.gov/pubmed/32024632 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e16831 %T Mobile App to Help People With Chronic Illness Reflect on Their Strengths: Formative Evaluation and Usability Testing %A Kristjansdottir,Olöf Birna %A Børøsund,Elin %A Westeng,Marianne %A Ruland,Cornelia %A Stenberg,Una %A Zangi,Heidi A %A Stange,Kurt %A Mirkovic,Jelena %+ Department for Digital Health Research, Division of Medicine, Oslo University Hospital, Pb 4959 Nydalen, Oslo, 0424, Norway, 47 92433964, olof@mestring.no %K mobile app %K self-management %K strengths %K chronic illness %K rheumatology %K usability %K formative evaluation %D 2020 %7 4.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Supporting patient engagement and empowerment is increasingly seen as essential in providing person-centered health care to people with chronic illness. Mobile apps helping patients reflect on their concerns as preparation for consultations with their health care providers can have beneficial effects on the consultation quality. However, apps focusing on empowerment and personal strengths are still scarce. Objective: This study aimed to (1) develop a mobile app to support patients with rheumatic diseases in reflecting on their strengths in preparation for consultations with health care providers and (2) explore patients’ perceived usability of the app in a nonclinical test setting. Methods: A prototype app was developed based on input from patients and health care providers, as reported in previous studies. The app was designed for use in self-management support settings aiming to promote awareness of strengths and to focus attention on strengths in the patient-health care provider dialogue. The features included in the prototype were as follows: (1) introduction to the topic of strengths, (2) list of examples of strengths to promote reflection and registration of own strengths, (3) summary of registered strengths, (4) value-based goal setting, (5) linking of strengths to goals, (6) summary of all registrations, and (7) options to share summary digitally or as a print version. In this study, the app was refined through a formative evaluation with patients and health care providers recruited from a specialized rheumatology hospital unit. Patients’ perceptions of the app’s usability were explored in a test setting with self-report measurements and semistructured interviews. The interviews were audiotaped, transcribed, and analyzed with directed content analysis. Data from questionnaires were analyzed with descriptive statistics. Results: Developmental and formative evaluation included 18 patients and 7 health care providers. The evaluation resulted in minor adjustments to the prototype but no major changes in features. The usability testing included 12 patients. All participants found the usability acceptable; the median score on the System Usability Scale was 86.3 (range 70-100). All reported that it was meaningful and relevant to use the app. Out of 12 participants, 9 (75%) reported becoming more aware of their own strengths by using the app; 1 (8%) disagreed and 2 (17%) provided a neutral response. The results on the goal-related feature were mixed, with half of the patients finding it useful to link strengths to concrete goals. A statistically significant positive change from pre- to postintervention was identified on measures of self-efficacy and negative emotions. Conclusions: In this formative evaluation of a mobile app to promote patients’ reflections on their strengths, patients perceived the app as meaningful and supporting awareness. The results suggest the usefulness of building in functionality to support use of strengths and goal attainment. Further studies on efficacy and usability in a clinical setting, including health care providers, are needed. %M 32130126 %R 10.2196/16831 %U https://formative.jmir.org/2020/3/e16831 %U https://doi.org/10.2196/16831 %U http://www.ncbi.nlm.nih.gov/pubmed/32130126 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e15346 %T A Culturally Relevant Smartphone-Delivered Physical Activity Intervention for African American Women: Development and Initial Usability Tests of Smart Walk %A Joseph,Rodney P %A Keller,Colleen %A Vega-López,Sonia %A Adams,Marc A %A English,Rebekah %A Hollingshead,Kevin %A Hooker,Steven P %A Todd,Michael %A Gaesser,Glenn A %A Ainsworth,Barbara E %+ Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 550 N 3rd St, Phoenix, AZ, 85004, United States, 1 6024960772, rodney.joseph@asu.edu %K eHealth %K mHealth %K exercise %K minority health %K primary prevention %K heart diseases %K African-American %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smart Walk is a culturally relevant, social cognitive theory–based, smartphone-delivered intervention designed to increase physical activity (PA) and reduce cardiometabolic disease risk among African American (AA) women. Objective: This study aimed to describe the development and initial usability testing results of Smart Walk. Methods: Smart Walk was developed in 5 phases. Phases 1 to 3 focused on initial intervention development, phase 4 involved usability testing, and phase 5 included intervention refinement based on usability testing results. In phase 1, a series of 9 focus groups with 25 AA women (mean age 38.5 years, SD 7.8; mean BMI 39.4 kg/m2, SD 7.3) was used to identify cultural factors associated with PA and ascertain how constructs of social cognitive theory can be leveraged in the design of a PA intervention. Phase 2 included the analysis of phase 1 qualitative data and development of the structured PA intervention. Phase 3 focused on the technical development of the smartphone app used to deliver the intervention. Phase 4 consisted of a 1-month usability trial of Smart Walk (n=12 women; mean age 35.0 years, SD 8.5; mean BMI 40 kg/m2, SD 5.0). Phase 5 included refinement of the intervention based on the usability trial results. Results: The 5-phase process resulted in the development of the Smart Walk smartphone-delivered PA intervention. This PA intervention was designed to target social cognitive theory constructs of behavioral capability, outcome expectations, social support, self-efficacy, and self-regulation and address deep structure sociocultural characteristics of collectivism, racial pride, and body appearance preferences of AA women. Key features of the smartphone app included (1) personal profile pages, (2) multimedia PA promotion modules (ie, electronic text and videos), (3) discussion boards, and (4) a PA self-monitoring tool. Participants also received 3 PA promotion text messages each week. Conclusions: The development process of Smart Walk was designed to maximize the usability, cultural relevance, and impact of the smartphone-delivered PA intervention. %M 32130198 %R 10.2196/15346 %U https://mhealth.jmir.org/2020/3/e15346 %U https://doi.org/10.2196/15346 %U http://www.ncbi.nlm.nih.gov/pubmed/32130198 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e14680 %T Supporting the Medication Adherence of Older Mexican Adults Through External Cues Provided With Ambient Displays: Feasibility Randomized Controlled Trial %A Zárate-Bravo,Ernesto %A García-Vázquez,Juan-Pablo %A Torres-Cervantes,Engracia %A Ponce,Gisela %A Andrade,Ángel G %A Valenzuela-Beltrán,Maribel %A Rodríguez,Marcela D %+ Facultad de Ingeniería, Universidad Autónoma de Baja California, Ave Alvaro Obregón, S/N, Col Nueva, Mexicali, 21100, Mexico, 52 6865664270 ext 1301, marcerod@uabc.edu.mx %K health information systems %K family caregiver %K aged %K medication adherence %D 2020 %7 2.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Problems with prospective memory, which refers to the ability to remember future intentions, cause deficits in basic and instrumental activities of daily living, such as taking medications. Older adults show minimal deficits when they rely on mostly preserved and relatively automatic associative retrieval processes. On the basis of this, we propose to provide external cues to support the automatic retrieval of an intended action, that is, to take medicines. To reach this end, we developed the Medication Ambient Display (MAD), a system that unobtrusively presents relevant information (unless it requires the users’ attention) and uses different abstract modalities to provide external cues that enable older adults to easily take their medications on time and be aware of their medication adherence. Objective: This study aimed to assess the adoption and effect of external cues provided through ambient displays on medication adherence in older adults. Methods: A total of 16 older adults, who took at least three medications and had mild cognitive impairment, participated in the study. We conducted a 12-week feasibility study in which we used a mixed methods approach to collect qualitative and quantitative evidence. The study included baseline, intervention, and postintervention phases. Half of the participants were randomly allocated to the treatment group (n=8), and the other half was assigned to the control group (n=8). During the study phases, research assistants measured medication adherence weekly through the pill counting technique. Results: The treatment group improved their adherence behavior from 80.9% at baseline to 95.97% using the MAD in the intervention phase. This decreased to 76.71% in the postintervention phase when the MAD was no longer being used. Using a one-way repeated measures analysis of variance and a post hoc analysis using the Tukey honestly significant difference test, we identified a significant statistical difference between the preintervention and intervention phases (P=.02) and between the intervention and postintervention phases (P=.002). In addition, the medication adherence rate of the treatment group (95.97%) was greater than that of the control group (88.18%) during the intervention phase. Our qualitative results showed that the most useful cues were the auditory reminders, followed by the stylized representations of medication adherence. We also found that the MAD’s external cues not only improved older adults’ medication adherence but also mediated family caregivers’ involvement. Conclusions: The findings of this study demonstrate that using ambient modalities for implementing external cues is useful for drawing the attention of older adults to remind them to take medications and to provide immediate awareness on adherence behavior. Trial Registration: ClinicalTrials.gov NCT04289246; https://tinyurl.com/ufjcz97 %M 32130164 %R 10.2196/14680 %U http://mhealth.jmir.org/2020/3/e14680/ %U https://doi.org/10.2196/14680 %U http://www.ncbi.nlm.nih.gov/pubmed/32130164 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e15919 %T Effectiveness of the Fun for Wellness Web-Based Behavioral Intervention to Promote Physical Activity in Adults With Obesity (or Overweight): Randomized Controlled Trial %A Myers,Nicholas D %A McMahon,Adam %A Prilleltensky,Isaac %A Lee,Seungmin %A Dietz,Samantha %A Prilleltensky,Ora %A Pfeiffer,Karin A %A Bateman,André G %A Brincks,Ahnalee M %+ Michigan State University, 201 IM Sports Circle Building, 308 W Circle Drive, East Lansing, MI, 48824, United States, 1 5174325380, myersni1@msu.edu %K eHealth %K mHealth %K self-efficacy theory %K physical activity self-efficacy level %K self-regulatory efficacy %K mediation %D 2020 %7 27.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Insufficient physical activity in the adult population is a global pandemic. Fun for Wellness (FFW) is a self-efficacy theory- and Web-based behavioral intervention developed to promote growth in well-being and physical activity by providing capability-enhancing opportunities to participants. Objective: This study aimed to evaluate the effectiveness of FFW to increase physical activity in adults with obesity in the United States in a relatively uncontrolled setting. Methods: This was a large-scale, prospective, double-blind, parallel-group randomized controlled trial. Participants were recruited through an online panel recruitment company. Adults with overweight were also eligible to participate, consistent with many physical activity–promoting interventions for adults with obesity. Also consistent with much of the relevant literature the intended population as simply adults with obesity. Eligible participants were randomly assigned to the intervention (ie, FFW) or the usual care (ie, UC) group via software code that was written to accomplish equal allocations to the FFW and UC groups. Data collection was Web based, fully automated, and occurred at three time points: baseline, 30 days after baseline (T2), and 60 days after baseline (T3). Participants (N=461) who were assigned to the FFW group (nFFW=219) were provided with 30 days of 24-hour access to the Web-based intervention. A path model was fit to the data consistent with the FFW conceptual model for the promotion of physical activity. Results: There was evidence for a positive direct effect of FFW on transport-related physical activity self-efficacy (beta=.22, P=.02; d=0.23), domestic-related physical activity self-efficacy (beta=.22, P=.03; d=0.22), and self-efficacy to regulate physical activity (beta=.16, P=.01; d=0.25) at T2. Furthermore, there was evidence for a positive indirect effect of FFW on physical activity at T3 through self-efficacy to regulate physical activity at T2 (beta=.42, 95% CI 0.06 to 1.14). Finally, there was evidence for a null direct effect of FFW on physical activity (beta=1.04, P=.47; d=0.07) at T3. Conclusions: This study provides some initial evidence for both the effectiveness (eg, a positive indirect effect of FFW on physical activity through self-efficacy to regulate physical activity) and the ineffectiveness (eg, a null direct effect of FFW on physical activity) of the FFW Web-based behavioral intervention to increase physical activity in adults with obesity in the United States. More broadly, FFW is a scalable Web-based behavioral intervention that may effectively, although indirectly, promote physical activity in adults with obesity and therefore may be useful in responding to the global pandemic of insufficient physical activity in this at-risk population. Self-efficacy to regulate physical activity appears to be a mechanism by which FFW may indirectly promote physical activity in adults with obesity. Trial Registration: ClinicalTrials.gov NCT03194854; https://clinicaltrials.gov/ct2/show/NCT03194854. %R 10.2196/15919 %U http://formative.jmir.org/2020/2/e15919/ %U https://doi.org/10.2196/15919 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e16410 %T A Patient-Centered Information System (myED) for Emergency Care Journeys: Design, Development, and Initial Adoption %A Westphal,Monika %A Yom-Tov,Galit Bracha %A Parush,Avi %A Carmeli,Nitzan %A Shaulov,Alina %A Shapira,Chen %A Rafaeli,Anat %+ Technion - Israel Institute of Technology, Technion City, Haifa, 3200003, Israel, 972 48294510, gality@technion.ac.il %K technology %K medical records %K access to information %K patient participation %K electronic patient-provider communication %K user-centered design %D 2020 %7 25.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Medical care is highly complex in that it addresses patient-centered health goals that require the coordination of multiple care providers. Emergency department (ED) patients currently lack a sense of predictability about ED procedures. This increases frustration and aggression. Herein, we describe a system for providing real-time information to ED patients regarding the procedures in their ED medical journey. Objective: This study aimed to develop a system that provides patients with dynamically updated information about the specific procedures and expected waiting times in their personal ED journey, and to report initial evaluations of this system. Methods: To develop the myED system, we extracted information from hospital databases and translated it using process mining and user interface design into a language that is accessible and comprehensible to patients. We evaluated the system using a mixed methods approach that combined observations, interviews, and online records. Results: Interviews with patients, accompanying family members, and health care providers (HCPs) confirmed patients’ needs for information about their personal ED journey. The system developed enables patients to access this information on their personal mobile phones through a responsive website. In the third month after deployment, 492 of 1614 (30.48%) patients used myED. Patients’ understanding of their ED journey improved significantly (F8,299=2.519; P=.01), and patients showed positive reactions to the system. We identified future challenges, including achieving quick engagement without delaying medical care. Salient reasons for poor system adoption were patients’ medical state and technological illiteracy. HCPs confirmed the potential of myED and identified means that could improve patient experience and staff cooperation. Conclusions: Our iterative work with ED patients, HCPs, and a multidisciplinary team of developers yielded a system that provides personal information to patients about their ED journey in a secure, effective, and user-friendly way. MyED communicates this information through mobile technology. This improves health care by addressing patients’ psychological needs for information and understanding, which are often overlooked. We continue to test and refine the system and expect to find positive effects of myED on patients’ ED experience and hospital operations. %M 32130144 %R 10.2196/16410 %U http://formative.jmir.org/2020/2/e16410/ %U https://doi.org/10.2196/16410 %U http://www.ncbi.nlm.nih.gov/pubmed/32130144 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e14888 %T Using an Electronic Medication Event–Monitoring System for Antiretroviral Therapy Self-Management Among African American Women Living With HIV in Rural Florida: Cohort Study %A Lucero,Robert %A Williams,Renessa %A Esalomi,Tanisia %A Alexander-Delpech,Paula %A Cook,Christa %A Bjarnadottir,Ragnhildur I %+ Department of Family, Community, and Health Systems Science, Southern HIV & Alcohol Research Consortium, University of Florida, College of Nursing, 1225 Center Drive, Gainesville, FL, United States, 1 3522736370, rlucero@ufl.edu %K medication adherence %K medication therapy management %K self-management %K HIV %K African Americans %D 2020 %7 19.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV remains a significant health issue in the United States and disproportionately affects African Americans. African American women living with HIV (AAWH) experience a particularly high number of barriers when attempting to manage their HIV care, including antiretroviral therapy (ART) adherence. To enable the development and assessment of effective interventions that address these barriers to support ART adherence, there is a critical need to understand more fully the use of objective measures of ART adherence among AAWH, including electronic medication dispensers for real-time surveillance. Objective: This study aimed to evaluate the use of the Wisepill medication event–monitoring system (MEMS) and compare the objective and subjective measures of ART adherence. Methods: We conducted a 30-day exploratory pilot study of the MEMS among a convenience sample of community-dwelling AAWH (N=14) in rural Florida. AAWH were trained on the use of the MEMS to determine the feasibility of collecting, capturing, and manipulating the MEMS data for an objective measure of ART adherence. Self-reported sociodemographic information, including a self-reported measure of ART adherence, was also collected from AAWH. Results: We found that the majority of participants were successful at using the electronic MEMS. Daily use of the MEMS tended to be outside of the usual time participants took their medication. Three 30-day medication event patterns were found that characterized ART adherence, specifically uniform and nonuniform medication adherence and nonuniform medication nonadherence. There were relatively few MEMS disruptions among study participants. Overall, adjusted daily ART adherence was 81.08% and subjective ART adherence was 77.78%. Conclusions: This pilot study on the use and evaluation of the Wisepill MEMS among AAWH in rural Florida is the first such study in the United States. The findings of this study are encouraging because 10 out of 12 participants consistently used the MEMS, there were relatively few failures, and objective adjusted daily and overall subjective ART adherence were very similar. On the basis of these findings, we think researchers should consider using the Wisepill MEMS in future studies of AAWH and people living with HIV in the United States after taking into account our practical suggestions. The following practical considerations are suggested when measuring objective medication adherence: (1) before using an MEMS, be familiar with the targeted populations’ characteristics; (2) choose an MEMS that aligns with the participants’ day-to-day activities; (3) ensure the MEMS’ features and resulting data support the research goals; (4) assess the match among the user’s ability, wireless features of the MEMS, and the geographic location of the participants; and (5) consider the cost of MEMS and the research budget. %M 32130114 %R 10.2196/14888 %U http://formative.jmir.org/2020/2/e14888/ %U https://doi.org/10.2196/14888 %U http://www.ncbi.nlm.nih.gov/pubmed/32130114 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 1 %P e16762 %T A Chatbot-Based Coaching Intervention for Adolescents to Promote Life Skills: Pilot Study %A Gabrielli,Silvia %A Rizzi,Silvia %A Carbone,Sara %A Donisi,Valeria %+ eHealth Unit, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461312477, sgabrielli@fbk.eu %K life skills %K chatbots %K conversational agents %K mental health %K participatory design %K adolescence %K bullying %K cyberbullying %K well-being intervention %D 2020 %7 14.2.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Adolescence is a challenging period, where youth face rapid changes as well as increasing socioemotional demands and threats, such as bullying and cyberbullying. Adolescent mental health and well-being can be best supported by providing effective coaching on life skills, such as coping strategies and protective factors. Interventions that take advantage of online coaching by means of chatbots, deployed on Web or mobile technology, may be a novel and more appealing way to support positive mental health for adolescents. Objective: In this pilot study, we co-designed and conducted a formative evaluation of an online, life skills coaching, chatbot intervention, inspired by the positive technology approach, to promote mental well-being in adolescence. Methods: We co-designed the first life skills coaching session of the CRI (for girls) and CRIS (for boys) chatbot with 20 secondary school students in a participatory design workshop. We then conducted a formative evaluation of the entire intervention—eight sessions—with a convenience sample of 21 adolescents of both genders (mean age 14.52 years). Participants engaged with the chatbot sessions over 4 weeks and filled in an anonymous user experience questionnaire at the end of each session; responses were based on a 5-point Likert scale. Results: A majority of the adolescents found the intervention useful (16/21, 76%), easy to use (19/21, 90%), and innovative (17/21, 81%). Most of the participants (15/21, 71%) liked, in particular, the video cartoons provided by the chatbot in the coaching sessions. They also thought that a session should last only 5-10 minutes (14/21, 66%) and said they would recommend the intervention to a friend (20/21, 95%). Conclusions: We have presented a novel and scalable self-help intervention to deliver life skills coaching to adolescents online that is appealing to this population. This intervention can support the promotion of coping skills and mental well-being among youth. %M 32130128 %R 10.2196/16762 %U http://humanfactors.jmir.org/2020/1/e16762/ %U https://doi.org/10.2196/16762 %U http://www.ncbi.nlm.nih.gov/pubmed/32130128 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e16090 %T Development and Field Evaluation of the INTER-ACT App, a Pregnancy and Interpregnancy Coaching App to Reduce Maternal Overweight and Obesity: Mixed Methods Design %A Bogaerts,Annick %A Bijlholt,Margriet %A Mertens,Lotte %A Braeken,Marijke %A Jacobs,Bart %A Vandenberghe,Bert %A Ameye,Lieveke %A Devlieger,Roland %+ Department of Development and Regeneration, University of Leuven, O&N IV Herestraat 49 - bus 805, Leuven, 3000, Belgium, 32 16 19 31 27, annick.bogaerts@kuleuven.be %K pregnancy %K postpartum %K coaching %K lifestyle %K mobile app %D 2020 %7 14.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The interpregnancy and pregnancy periods are important windows of opportunity to prevent excessive gestational weight retention. Despite an overwhelming number of existing health apps, validated apps to support a healthy lifestyle between and during pregnancies are lacking. Objective: To describe the development and evaluation of the INTER-ACT app, which is part of an interpregnancy and pregnancy lifestyle coaching module, to prevent excessive weight gain in pregnancy and enhance optimal weight and a healthy lifestyle in the interpregnancy period. Methods: A mixed methods design was used to identify the needs of health care providers and end users, according to 15 semistructured interviews, two focus groups, and two surveys. The user interface was evaluated in a pilot study (N=9). Results: Health care providers indicated that a mobile app can enhance a healthy lifestyle in pregnant and postpartum women. Pregnant women preferred graphic displays in the app, weekly notifications, and support messages according to their own goals. Both mothers and health care providers reported increased awareness and valued the combination of the app with face-to-face coaching. Conclusions: The INTER-ACT app was valued by its end users because it was offered in combination with face-to-face contact with a caregiver. %M 32130109 %R 10.2196/16090 %U http://formative.jmir.org/2020/2/e16090/ %U https://doi.org/10.2196/16090 %U http://www.ncbi.nlm.nih.gov/pubmed/32130109 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e14189 %T Usability of the Turkish Translation of the Dutch Talking Touch Screen Questionnaire for Physical Therapy Patients With a Turkish Background: Qualitative Study %A Welbie,Marlies %A Wittink,Harriet %A Bozkurt,Sahin %A Coban,Tugba %A Devillé,Walter LJM %+ Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Postbus 12011, Utrecht, 3501 AA Utrecht, Netherlands, 31 638192100, marlies.welbie@hu.nl %K mHealth %K eHealth %K surveys and questionnaires %K physical therapy specialty %K qualitative research %D 2020 %7 13.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The Turkish translation of the Dutch Talking Touch Screen Questionnaire (TTSQ) has been developed to help physical therapy patients with a Turkish background in the Netherlands to autonomously elucidate their health problems and impairments and set treatment goals, regardless of their level of health literacy. Objective: The aim of this study was to evaluate the usability of the Turkish TTSQ for physical therapy patients with a Turkish background with diverse levels of health literacy and experience in using mobile technology. Methods: The qualitative Three-Step Test-Interview method was carried out to gain insight into the usability of the Turkish TTSQ. A total of 10 physical therapy patients participated. The interview data were analyzed using a thematic content analysis approach aimed at determining the accuracy and completeness with which participants completed the questionnaire (effectiveness), the time it took participants to complete the questionnaire (efficiency), and the extent to which the participants were satisfied with the ease of use of the questionnaire (satisfaction). The problems encountered by the participants in this study were given a severity rating, which was used to provide a rough estimate of the need for additional usability improvements. Results: No participant in this study was able to complete the questionnaire without encountering at least one usability problem. A total of 17 different kinds of problems were found. On the basis of their severity score, 3 problems that should be addressed during future development of the tool were “Not using the navigation function of the photo gallery in Question 4 causing the participant to not see all presented response items;” “Touching the text underneath a photo in Question 4 to select an activity instead of touching the photo itself, causing the activity not to be selected;” and “Pushing too hard or tapping too softly on the touch screen causing the touch screen to not respond.” The data on efficiency within this study were not valid and are, therefore, not reported in this study. No participant was completely satisfied or dissatisfied with the overall ease of use of the Turkish TTSQ. Two participants with no prior experience of using tablet computers felt that, regardless of what kinds of improvement might be made, it would just be too difficult for them to learn to work with the device. Conclusions: As with the Dutch TTSQ, the Turkish TTSQ needs improvement before it can be released. The results of this study confirm the conclusion of the Dutch TTSQ study that participants with low levels of education and little experience in using mobile technology are less able to operate the TTSQ effectively. Using a Dutch speaking interviewer and Turkish interpreter has had a negative effect on data collection in this study. %M 32053112 %R 10.2196/14189 %U http://formative.jmir.org/2020/2/e14189/ %U https://doi.org/10.2196/14189 %U http://www.ncbi.nlm.nih.gov/pubmed/32053112 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e14496 %T A Weekly, Evidence-Based Health Letter for Caregivers (90Second Caregiver): Usability Study %A Milios,Athena %A McGrath,Patrick %A Baillie,Hannah %+ Centre for Research in Family Health, IWK Health Centre, 5980 University Ave, Halifax, NS, Canada, 1 9025790269, athena.milios1@gmail.com %K caregivers %K mental health %K usability %K depression %K anxiety %K stigma %K hope %K health information %K persuasive design %D 2020 %7 12.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Informal caregivers are family members or close friends who provide unpaid help to individuals with acute or chronic health conditions so that they can manage daily life tasks. The greatest source of health information is the internet for meeting the needs of caregivers. However, information on the internet may not be scientifically valid, it may be written in language that is difficult to read, and is often in very large doses. 90Second Caregiver is a health letter whose aim is to disseminate knowledge to caregivers in a user-friendly, weekly format, in order to improve their wellbeing. Objective: The main objective was to test a sample of 90Second Caregiver health letters in order to assess their usability and to optimize the design and content of the health letters. Methods: Usability research themes were assessed using semi-structured phone interviews, incorporating the Think Aloud method with retrospective questioning. Results: Usability was assessed in the context of five main themes: understandability and learnability, completeness, relevance, and quality and credibility of the health letter content, as well as design and format. Caregivers generally provided positive feedback regarding the usability of the letters. The usability feedback was used to refine 90Second Caregiver in order to improve the design and content of the series. Based on the results of this study, it may be of maximum benefit to target the series towards individuals who are new to caregiving or part-time caregivers, given that these caregivers of the sample found the letters more useful and relevant and had the most positive usability experiences. Conclusions: The findings assisted in the improvement of the 90Second Caregiver template, which will be used to create future health letters and refine the letters that have already been created. The findings have implications for who the 90Second Caregiver series should be targeting (ie, newer or part-time caregivers) in order to be maximally impactful in improving mental health and wellbeing-related outcomes for caregivers, such as self-efficacy and caregiving knowledge. The results of this study may be generalizable to the examination of other electronic health information formats, making them valuable to future researchers testing the usability of health information products. In addition, the methods used in this study are useful for usability hypothesis generation. Lastly, our 90Second delivery approach can generate information useful for a set of similar products (eg, weekly health letters targeted towards other conditions/populations). %M 32049064 %R 10.2196/14496 %U https://formative.jmir.org/2020/2/e14496 %U https://doi.org/10.2196/14496 %U http://www.ncbi.nlm.nih.gov/pubmed/32049064 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e16807 %T Feasibility and Acceptability of an Electronic Health HIV Prevention Toolkit Intervention With Concordant HIV-Negative, Same-Sex Male Couples on Sexual Agreement Outcomes: Pilot Randomized Controlled Trial %A Mitchell,Jason William %A Lee,Ji-Young %A Wu,Yanyan %A Sullivan,Patrick S %A Stephenson,Rob %+ Office of Public Health Studies, Myron B Thompson School of Social Work, University of Hawaii, 1960 East-West Rd, Suite T103, Honolulu, HI, 96822, United States, 1 8082196729, jasonmit@hawaii.edu %K telemedicine %K HIV %K couples %K sexual and gender minorities %D 2020 %7 11.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a need to develop innovative and accessible dyadic interventions that provide male couples with the behavioral skills to manage the risk of HIV transmission within their relationship. Objective: We conducted a pilot randomized controlled trial (RCT) to assess the feasibility and acceptability of the electronic health (eHealth) HIV prevention toolkit intervention to encourage seroconcordant negative male couples in the United States to establish and adhere to a sexual agreement (SA). Methods: Eligible, consented couples were randomly assigned to the intervention or education control and followed up for 6 months, with assessments occurring every 3 months after baseline. Acceptability items were assessed at both follow-up assessments. Descriptive and comparative statistics summarized cohort characteristics, relationship dynamics, and SA outcomes for the entire cohort and by trial arm. To examine the association between couples’ relationship dynamics and their establishment of an SA over time and by trial arm, multilevel logistic regression analyses were performed with a random intercept to account for correlations of repeated measurements of relationship dynamics at months 3 and 6; the odds ratio (OR) of establishment of an SA and the corresponding 95% confidence interval were then reported. Results: Overall, 7959 individuals initiated screening. Reasons for individual ineligibility varied. An electronic algorithm was used to assess couple-level eligibility, which identified 1080 ineligible and 266 eligible dyads. Eligible couples (n=149) were enrolled in the pilot RCT: 68 received the intervention and 81 received the education control. Retention was 71.5% (213/298 partnered men) over the 6 months. Participants reported high acceptability of the intervention along with some areas for improvement. A significantly higher proportion of couples who received the intervention established an SA at 6 months compared with those who received the education control (32/43, 74% vs 27/50, 54%; P=.05). The OR of establishing an SA for couples in the intervention versus those in the control condition was greater than 2 when controlling for a number of different relationship dynamics. In addition, the odds of establishing an SA increased by 88% to 322% for each unit increase in a variety of averaged relationship dynamic scores; the opposite result was found for dynamics of stigma. Differences between trial arms for SA type and adherence were nonsignificant at each assessment. However, changes in these 2 SA aspects were noted over time. The average number of items couples included in their SA was 18, and about one-fourth to one-third of couples included HIV prevention items. Conclusions: The findings demonstrate strong evidence for the acceptability and feasibility of the eHealth toolkit as a brief, stand-alone, couples-based HIV prevention intervention. These findings support the need to update the toolkit and evaluate it in a larger clinical trial powered for efficacy. Trial Registration: ClinicalTrials.gov NCT02494817; http://clinicaltrials.gov/ct2/show/NCT02494817 %R 10.2196/16807 %U https://formative.jmir.org/2020/2/e16807 %U https://doi.org/10.2196/16807 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e13197 %T A Telehealth-Delivered Pulmonary Rehabilitation Intervention in Underserved Hispanic and African American Patients With Chronic Obstructive Pulmonary Disease: A Community-Based Participatory Research Approach %A Pekmezaris,Renee %A Kozikowski,Andrzej %A Pascarelli,Briana %A Wolf-Klein,Gisele %A Boye-Codjoe,Eugenia %A Jacome,Sonia %A Madera,Danielle %A Tsang,Donna %A Guerrero,Brenda %A Medina,Richard %A Polo,Jennifer %A Williams,Myia %A Hajizadeh,Negin %+ Northwell Health, 600 Community Dr, Manhasset, NY, 11030, United States, 1 5166001402, RPekmeza@northwell.edu %K COPD %K pulmonary rehabilitation %K telehealth %K CPBR %K disparities %K telemonitoring %D 2020 %7 31.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Although home telemonitoring (TM) is a promising approach for patients managing their chronic disease, rehabilitation using home TM has not been tested for use with individuals living with chronic obstructive pulmonary disease (COPD) residing in underserved communities. Objective: This study aimed to analyze qualitative data from focus groups with key stakeholders to ensure the acceptability and usability of the TM COPD intervention. Methods: We utilized a community-based participatory research (CBPR) approach to adapt a home TM COPD intervention to facilitate acceptability and feasibility in low-income African American and Hispanic patients. The study engaged community stakeholders in the process of modifying the intervention in the context of 2 community advisory board meetings. Discussions were audio recorded and professionally transcribed and lasted approximately 2 hours each. Structural coding was used to mark responses to topical questions in interview guides. Results: We describe herein the formative process of a CBPR study aimed at optimizing telehealth utilization among African American and Latino patients with COPD from underserved communities. A total of 5 major themes emerged from qualitative analyses of community discussions: equipment changes, recruitment process, study logistics, self-efficacy, and access. The identification of themes was instrumental in understanding the concerns of patients and other stakeholders in adapting the pulmonary rehabilitation (PR) home intervention for acceptability for patients with COPD from underserved communities. Conclusions: These findings identify important adaptation recommendations from the stakeholder perspective that should be considered when implementing in-home PR via TM for underserved COPD patients. Trial Registration: ClinicalTrials.gov NCT03007485; https://clinicaltrials.gov/ct2/show/NCT03007485 %M 32012039 %R 10.2196/13197 %U https://formative.jmir.org/2020/1/e13197 %U https://doi.org/10.2196/13197 %U http://www.ncbi.nlm.nih.gov/pubmed/32012039 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e13495 %T “Positive Peers”: Function and Content Development of a Mobile App for Engaging and Retaining Young Adults in HIV Care %A Step,Mary M %A McMillen Smith,Jennifer %A Kratz,Joshua %A Briggs,Julia %A Avery,Ann %+ College of Public Health, Kent State University, 321 Lowry Hall, 750 Hilltop Dr, Kent, OH, 44242-0001, United States, 1 2164036048, MSTEP@KENT.EDU %K HIV %K young adults %K mobile applications %K self-management %D 2020 %7 30.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Although treatment for HIV infection is widely available and well tolerated, less than 30% of adolescents and young adults living with HIV infection achieve stable viral suppression. Mobile technology affords increased opportunities for young people living with HIV to engage with information, health management tools, and social connections that can support adherence to treatment recommendations and medication. Although mobile apps are increasingly prevalent, few are informed by the target population. Objective: The objective of this study was to describe the “Positive Peers” app, a mobile app currently being evaluated in a public hospital in the Midwestern United States. Formative development, key development strategies, user recruitment, and lessons learned are discussed in this paper. Methods: “Positive Peers” was developed in collaboration with a community advisory board (CAB) comprising in-care young adults living with HIV and a multidisciplinary project team. Mobile app functions and features were developed over iterative collaborative sessions that were tailored to the CAB members. In turn, the CAB built rapport with the project team and revealed unique information that was used in app development. Results: The study was funded on September 1, 2015; approved by the MetroHealth Institutional Review Board on August 31, 2016; and implemented from October 11, 2016, to May 31, 2019. The “Positive Peers” mobile app study has enrolled 128 users who reflect priority disparity population subgroups. The app administrator had frequent contact with users across app administration and study-related activities. Key lessons learned from the study include changing privacy concerns, data tracking reliability, and user barriers. Intermediate and outcome variable evaluation is expected in October 2019. Conclusions: Successful development of the “Positive Peers” mobile app was supported by multidisciplinary expertise, an enthusiastic CAB, and a multifaceted, proactive administrator. %M 32012035 %R 10.2196/13495 %U http://formative.jmir.org/2020/1/e13495/ %U https://doi.org/10.2196/13495 %U http://www.ncbi.nlm.nih.gov/pubmed/32012035 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e14111 %T Challenges and Lessons Learned From a Mobile Health, Web-Based Human Papillomavirus Intervention for Female Korean American College Students: Feasibility Experimental Study %A Kim,Minjin %A Lee,Haeok %A Allison,Jeroan %+ University of Massachusetts Medical School, Department of Population and Quantitative Health Sciences, 368 Plantation Street, Worcester, MA, 01605, United States, 1 7202095559, minjin.kim2@umassmed.edu %K mHealth %K Web-based intervention %K fraud %K experimental design %D 2020 %7 29.1.2020 %9 Short Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) and Web-based research methods are becoming more commonplace for researchers. However, there is a lack of mHealth and Web-based human papillomavirus (HPV) prevention experimental studies that discuss potential issues that may arise. Objective: This study aimed to assess the feasibility of research procedures and discuss the challenges and lessons learned from an mHealth and Web-based HPV prevention experimental study targeting female Korean American college students in the United States. Methods: A pilot randomized controlled trial (RCT) was conducted in an mHealth and Web-based platform with 104 female Korean American college students aged 18-26 years between September 2016 and December 2016. Participants were randomized to either the experimental group (a storytelling video intervention) or the comparison group (a nonnarrative, information-based intervention). Outcomes included the feasibility of research procedures (recruitment, eligibility, randomization, and retention). Results: From September 2016 to October 2016, we recorded 225 entries in our initial eligibility survey. The eligibility rate was 54.2% (122/225). This study demonstrated a high recruitment rate (95.6%, 111/122) and retention rate (83.7%, 87/104) at the 2-month follow-up. Conclusions: Findings from this study demonstrated sufficient feasibility in terms of research procedures to justify a full-scale RCT. Given the increased possibility of invalid or misrepresentative entries in mHealth and Web-based studies, strategies for detection and prevention are critical. Trial Registration: ISRCTN Registry ISRCTN12175285; http://www.isrctn.com/ISRCTN12175285 %M 32012036 %R 10.2196/14111 %U http://formative.jmir.org/2020/1/e14111/ %U https://doi.org/10.2196/14111 %U http://www.ncbi.nlm.nih.gov/pubmed/32012036 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e12917 %T Development of a Mobile Phone App to Promote Safe Sex Practice Among Youth in Stockholm, Sweden: Qualitative Study %A Nielsen,Anna %A Bågenholm,Aspasia %A De Costa,Ayesha %+ Karolinska Institutet, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, 17176, Sweden, 46 704078496, anna.nielsen.1@ki.se %K mHealth %K youth %K sexual health %K condoms %K Sweden %D 2020 %7 28.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) has been shown to be effective in increasing knowledge of sexual health among youth. To date, evaluations mostly refer to interventions delivered via computer, email, and text messages. The possibility of downloading apps on mobile devices has opened up opportunities to develop engaging interventions on safe sexual health promotion. To attract young users and have them engage with a sexual health app, it is important to involve youth in intervention development. Objective: This study aimed to obtain input from youth on the content of a mobile phone app intended to promote safe sex and increase condom use among youth in Stockholm. Methods: This study was conducted at the Youth Health Clinics (YHC) in Stockholm County, Sweden. A total of 15 individual in-depth interviews and 2 focus group discussions (with youth aged 18-23 years) were conducted at the YHC in Stockholm. Areas explored were: (1) youth perceptions of condom use (advantages and obstacles), (2) perceptions of mHealth to promote safe sexual practices, and (3) content development for a mobile phone app to promote safe sex. Results: The smartphone app was developed based on the categories that emerged from the data. With regard to content, youth requested sex education, including information on sexually transmitted infections. In addition, condom-specific information, including practical usage technique, advice on how to have the condom talk, and how to decrease shame related to condom use, was requested. Youth suggested different modes to deliver the content, including text messages, movie clips, and push notifications. It was suggested that the tone of the messages delivered should be fun, entertaining, and supportive. The inputs from youth influenced the development of the following sections of the app: Condom Obstacles and Solutions; Quiz; Games; Self-Refection; Challenges; Stories by Peers (stories from peers and information from a doctor); Condom Tips, Pep Talk, and Boosting; and Random Facts. Conclusions: It is important to use input from youth when developing a smartphone intervention since the success of the intervention largely depends on the level of engagement and usage by youth. Furthermore, if proven efficient in increasing condom use, it is important that the development, including content and mode, is thoroughly described so that the intervention can be replicated. Likewise, if proven inefficient, it is important to learn from mistakes to improve and adjust the intervention. The effect of this smartphone app on safe sexual practices among youth is being evaluated in a pragmatic randomized controlled trial in Stockholm (ISRCTN13212899) and will be reported separately. %M 32012038 %R 10.2196/12917 %U https://formative.jmir.org/2020/1/e12917 %U https://doi.org/10.2196/12917 %U http://www.ncbi.nlm.nih.gov/pubmed/32012038 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e13207 %T A Co-Designed Social Media Intervention to Satisfy Information Needs and Improve Outcomes of Patients With Chronic Kidney Disease: Longitudinal Study %A Vasilica,Cristina Mihaela %A Brettle,Alison %A Ormandy,Paula %+ The University of Salford, School of Health and Society, Room 192, Mary Seacole Building, Salford, M6 6PU, United Kingdom, 44 0161 295 5342, C.M.Vasilica1@salford.ac.uk %K social media %K patients outcomes %K long term condition %K chronic kidney disease %K self-efficacy %K patients information needs %K co-design %D 2020 %7 27.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The number of people living with a long-term condition is increasing worldwide. Social media offers opportunities for patients to exchange information and experiences with others with the same condition, potentially leading to better self-management and improved patient outcomes, at minimal costs to health service providers. Objective: This paper describes how an online network with a range of social media platforms was created, with the help of a group of patients with chronic kidney disease and specialist professionals. The project considered whether information needs and health-related and social outcomes were met. Methods: We performed a longitudinal in-depth evaluation of the creation of the moderated network, observation of the use of the platforms, self-efficacy surveys (at baseline and 6 months), and semistructured interviews (at baseline and 6 months). Results: A total of 15 patients and professionals participated in the co-design of the network (hub), which was initially launched with 50 patients. Several platforms were needed to engage patients at different levels and encourage generation of information, with the support of moderators. In addition, 14 separate patients participated in the evaluation. Satisfaction of information needs through social engagement improved self-efficacy (n=13) with better self-care and management of illness. Social outcomes included seeking employment and an increase in social capital. Conclusions: An online network (hub) with several social media platforms helped patients with chronic kidney disease manage their condition. Careful co-designing with users resulted in a sustainable network with wider applicability across health and social care. %M 32012040 %R 10.2196/13207 %U https://formative.jmir.org/2020/1/e13207 %U https://doi.org/10.2196/13207 %U http://www.ncbi.nlm.nih.gov/pubmed/32012040 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e12618 %T Designing a Mobile App to Enhance Parenting Skills of Latinx Parents: A Community-Based Participatory Approach %A Doty,Jennifer L %A Brady,Sonya S %A Monardez Popelka,Javiera %A Rietveld,Laura %A Garcia-Huidobro,Diego %A Doty,Matthew J %A Linares,Roxana %A Svetaz,Maria Veronica %A Allen,Michele L %+ Department of Family, Youth and Community Sciences, University of Florida, 3038D McCarty Hall D, PO Box, Gainesville, FL, 32611-0001, United States, 1 3522733543, jennifer.doty@ufl.edu %K mobile application %K eHealth %K community-based participatory research %K Hispanic Americans, family %D 2020 %7 24.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Latinx families are among the highest users of smartphones, yet few health-focused Web programs have been developed for this audience. Parent-based smartphone apps designed for Latinx families may help increase access to evidence-informed parenting programming and ultimately reduce health disparities among children and adolescents. To maximize uptake of such apps, the Center for eHealth Research and Disease Management (CeHRes) Roadmap for electronic health (eHealth) development recommends 5 phases of development: (1) contextual inquiry, (2) value specification, (3) design, (4) operationalization, and (5) evaluation. Objective: Guided by the CeHRes Roadmap, our objective was to apply a community-based participatory research (CBPR) approach to mobile app development. We present a formative evaluation to inform the design of an eHealth mobile app for Latinx parents of adolescents based on a face-to-face parenting program, Padres Informados/Jovenes Preparados (PIJP). Methods: Community participants in the process included Latinx parents and stakeholders. We conducted a parent survey (N=115) and interviews (N=20) to understand the context and obtain feedback on a mockup and prototype of the app, facilitator workshops to streamline content, and stakeholder interviews (N=4) to discuss values and app requirements. Results: We report results from the first 3 phases of the CeHRes Roadmap. In the survey, 96.5% (111/115) of parents reported they had access to a cell phone, 85.6% (89/104) reported they would use a parenting app in the next month if they had access, and 80.2% (89/111) reported intentions to use a stress reduction app. Parents reported that setting goals about parenting and tracking those goals were important potential features of an app. In logistic regression analyses, technology attitudes and barriers were not related to parent’s intentions to use a parenting mobile app (95% CI 0.51-1.17 and 95% CI 0.28-2.12, respectively). Qualitative interviews confirmed Latinx parents’ technology engagement and desire for education and child development information online. Stakeholder interviews identified 3 community values: familism, the promotion of adolescent health, and delivery of economic value. Community stakeholders participated in defining the mobile app requirements. On the basis of community and parent input, the mobile app prototype was designed with 3 sections: (1) 8 modules of video-based parenting skills instruction with content from the face-to-face PIJP program, (2) breath rate information from a wearable device to support awareness of stress levels that could affect parenting, and (3) goal setting and tracking capacities. Conclusions: The findings of this study highlight the utility of an iterative, participatory design process. The CBPR approach and community collaboration enhanced the CeHRes Roadmap by promoting power sharing, facilitating recruitment, and building trust among community members. Experiences applying community research to the initial 3 phases of the CeHRes Roadmap in a Latinx community are discussed, along with plans for the 2 final phases. %M 32012034 %R 10.2196/12618 %U https://formative.jmir.org/2020/1/e12618 %U https://doi.org/10.2196/12618 %U http://www.ncbi.nlm.nih.gov/pubmed/32012034 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e12538 %T The Use and Effects of an App-Based Physical Activity Intervention “Active2Gether” in Young Adults: Quasi-Experimental Trial %A Middelweerd,Anouk %A Mollee,Julia %A Klein,Michel MCA %A Manzoor,Adnan %A Brug,Johannes %A te Velde,Saskia J %+ Research Center for Healthy and Sustainable Living, Hogeschool Utrecht University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS, Netherlands, 31 614752495, saskia.tevelde@hu.nl %K physical activity %K smartphone %K mobile app %D 2020 %7 21.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Insufficient physical activity (PA) is highly prevalent and associated with adverse health conditions and the risk of noncommunicable diseases. To increase levels of PA, effective interventions to promote PA are needed. Present-day technologies such as smartphones, smartphone apps, and activity trackers offer several possibilities in health promotion. Objective: This study aimed to explore the use and short-term effects of an app-based intervention (Active2Gether) to increase the levels of PA in young adults. Methods: Young adults aged 18-30 years were recruited (N=104) using diverse recruitment strategies. The participants were allocated to the Active2Gether-Full condition (tailored coaching messages, self-monitoring, and social comparison), Active2Gether-Light condition (self-monitoring and social comparison), and the Fitbit-only control condition (self-monitoring). All participants received a Fitbit One activity tracker, which could be synchronized with the intervention apps, to monitor PA behavior. A 12-week quasi-experimental trial was conducted to explore the intervention effects on weekly moderate-to-vigorous PA (MVPA) and relevant behavioral determinants (ie, self-efficacy, outcome expectations, social norm, intentions, satisfaction, perceived barriers, and long-term goals). The ActiGraph wGT3XBT and GT3X+ were used to assess baseline and postintervention follow-up PA. Results: Compared with the Fitbit condition, the Active2Gether-Light condition showed larger effect sizes for minutes of MVPA per day (regression coefficient B=3.1; 95% CI −6.7 to 12.9), and comparatively smaller effect sizes were seen for the Active2Gether-Full condition (B=1.2; 95% CI −8.7 to 11.1). Linear and logistic regression analyses for the intervention effects on the behavioral determinants at postintervention follow-up showed no significant intervention effects of the Active2Gether-Full and Active2Gether-Light conditions. The overall engagement with the Fitbit activity tracker was high (median 88% (74/84) of the days), but lower in the Fitbit condition. Participants in the Active2Gether conditions reported more technical problems than those in the Fitbit condition. Conclusions: This study showed no statistically significant differences in MVPA or determinants of MVPA after exposure to the Active2Gether-Full condition compared with the Active2Gether-Light or Fitbit condition. This might partly be explained by the small sample size and the low rates of satisfaction in the participants in the two Active2Gether conditions that might be because of the high rates of technical problems. %M 31961330 %R 10.2196/12538 %U http://formative.jmir.org/2020/1/e12538/ %U https://doi.org/10.2196/12538 %U http://www.ncbi.nlm.nih.gov/pubmed/31961330 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e14780 %T A Web-Based Communication Platform to Improve Home Care Services in Norway (DigiHelse): Pilot Study %A Støme,Linn Nathalie %A Moger,Tron %A Kidholm,Kristian %A Kværner,Kari J %+ Centre for Connected Care, Oslo University Hospital, Kirkeveien 166, Oslo, , Norway, 47 94880825, linast@ous-hf.no %K early health technology assessment %K eHealth %K primary care %K innovation %K behavioral data %D 2020 %7 20.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Home care service in Norway is struggling to meet the increasing demand for health care under restricted budget constraints, although one-fourth of municipal budgets are dedicated to health services. The integration of Web-based technology in at-home care is expected to enhance communication and patient involvement, increase efficiency and reduce cost. DigiHelse is a Web-based platform designed to reinforce home care service in Norway and is currently undergoing a development process to meet the predefined needs of the country’s municipalities. Some of the main features of the platform are digital messages between residents and the home care service, highlighting information on planned and completed visits, the opportunity to cancel visits, and notifications for completed visits. Objective: This study aimed to test the usability and economic feasibility of adopting DigiHelse in four districts in Oslo by applying registry and behavioral data collected throughout a one-year pilot study. Early health technology assessment was used to estimate the potential future value of DigiHelse, including the predictive value of behavior data. Methods: Outcome measures identified by stakeholder insights and scenario drafting in the project’s concept phase were used to assess potential socioeconomic benefits. Aggregated data were collected to assess changes in health consumption at baseline, and then 15 and 52 weeks after DigiHelse was implemented. The present value calculation was updated with data from four intervention groups and one control group. A quasi-experimental difference-in-difference design was applied to estimate the causal effect. Descriptive behavioral data from the digital platform was applied to assess the usability of the platform. Results: Over the total study period (52 weeks), rates increased for all outcome estimates: the number of visits (rate ratio=1.04; P=.10), unnecessary trips (rate ratio=1.37; P=.26), and phone calls (rate ratio=1.24; P=.08). A significant gap was found between the estimated value of DigiHelse in the concept phase and after the one-year pilot. In the present pilot assessment, costs are expected to exceed potential savings by €67 million (US $75 million) over ten years, as compared to the corresponding concept estimates of a potential gain of €172.6 million (US $193.6 million). Interestingly, behavioral data from the digital platform revealed that only 3.55% (121/3405) of recipients actively used the platform after one year. Conclusions: Behavioral data provides a valuable source for assessing usability. In this pilot study, the low adoption rate may, at least in part, explain the inability of DigiHelse to perform as expected. This study points to an early assessment of behavioral data as an opportunity to identify inefficiencies and direct digital development. For DigiHelse, insight into why the recipients in Oslo have not made greater use of the Web-based platform seems to be the next step in ensuring the right improvement measures for the home care service. %M 31958062 %R 10.2196/14780 %U http://formative.jmir.org/2020/1/e14780/ %U https://doi.org/10.2196/14780 %U http://www.ncbi.nlm.nih.gov/pubmed/31958062 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e16652 %T A Smartphone App Designed to Help Cancer Patients Stop Smoking: Results From a Pilot Randomized Trial on Feasibility, Acceptability, and Effectiveness %A Bricker,Jonathan B %A Watson,Noreen L %A Heffner,Jaimee L %A Sullivan,Brianna %A Mull,Kristin %A Kwon,Diana %A Westmaas,Johann Lee %A Ostroff,Jamie %+ Fred Hutchinson Cancer Research Center, Division of Public Health Sciences, 1100 Fairview Avenue N, Seattle, WA, 98109, United States, 1 2066675074, jbricker@fredhutch.org %K smartphone app %K mHealth %K tobacco %K smoking %K cancer patient %D 2020 %7 17.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Persistent smoking after a cancer diagnosis predicts worse treatment outcomes and mortality, but access to effective smoking cessation interventions is limited. Smartphone apps can address this problem by providing a highly accessible, low-cost smoking cessation intervention designed for patients with a recent cancer diagnosis. Objective: This study aimed to summarize our development process and report the trial design, feasibility, participant acceptability, preliminary effectiveness, and impact on processes of change (eg, cancer stigma) of the first-known smoking cessation smartphone app targeted for cancer patients. Methods: We used an agile, user-centered design framework to develop a fully automated smartphone app called Quit2Heal that provided skills training and stories from cancer survivors focusing on coping with internalized shame, cancer stigma, depression, and anxiety as core triggers of smoking. Quit2Heal was compared with the National Cancer Institute’s QuitGuide, a widely used stop smoking app for the general population, in a pilot double-blinded randomized trial with a 2-month follow-up period. Participants were 59 adult smokers diagnosed with cancer within the past 12 months and recruited through 2 cancer center care networks and social media over a 12-month period. The most common types of cancer diagnosed were lung (21/59, 36%) and breast (10/59, 17%) cancers. The 2-month follow-up survey retention rate was 92% (54/59) and did not differ by study arm (P=.15). Results: Compared with QuitGuide participants, Quit2Heal participants were more satisfied with their assigned app (90% [19/21] for Quit2Heal vs 65% [17/26] for QuitGuide; P=.047) and were more likely to report that the app assigned to them was made for someone like them (86% [18/21] for Quit2Heal vs 62% [16/26] for QuitGuide; P=.04). Quit2Heal participants opened their app a greater number of times during the 2-month trial period, although this difference was not statistically significant (mean 10.0, SD 14.40 for Quit2Heal vs mean 6.1, SD 5.3 for QuitGuide; P=.33). Self-reported 30-day point prevalence quit rates at the 2-month follow-up were 20% (5/25) for Quit2Heal versus 7% (2/29) for QuitGuide (odds ratio 5.16, 95% CI 0.71-37.29; P=.10). Quit2Heal participants also showed greater improvement in internalized shame, cancer stigma, depression, and anxiety, although these were not statistically significant (all P>.05). Conclusions: In a pilot randomized trial with a high short-term retention rate, Quit2Heal showed promising acceptability and effectiveness for helping cancer patients stop smoking. Testing in a full-scale randomized controlled trial with a longer follow-up period and a larger sample size is required to test the effectiveness, mediators, and moderators of this promising digital cessation intervention. Trial Registration: ClinicalTrials.gov NCT03600038; https://clinicaltrials.gov/ct2/show/NCT03600038 %M 31951215 %R 10.2196/16652 %U http://formative.jmir.org/2020/1/e16652/ %U https://doi.org/10.2196/16652 %U http://www.ncbi.nlm.nih.gov/pubmed/31951215 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e13296 %T Using Natural Language Processing to Examine the Uptake, Content, and Readability of Media Coverage of a Pan-Canadian Drug Safety Research Project: Cross-Sectional Observational Study %A Mohammadhassanzadeh,Hossein %A Sketris,Ingrid %A Traynor,Robyn %A Alexander,Susan %A Winquist,Brandace %A Stewart,Samuel Alan %+ Dalhousie University, 5790 University Ave, Room 408, Halifax, NS, B3H 4R2, Canada, 1 902 494 6287, sam.stewart@dal.ca %K natural language processing %K mass media %K readability %K pharmacoepidemiology %K knowledge translation %D 2020 %7 14.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Isotretinoin, for treating cystic acne, increases the risk of miscarriage and fetal abnormalities when taken during pregnancy. The Health Canada–approved product monograph for isotretinoin includes pregnancy prevention guidelines. A recent study by the Canadian Network for Observational Drug Effect Studies (CNODES) on the occurrence of pregnancy and pregnancy outcomes during isotretinoin therapy estimated poor adherence to these guidelines. Media uptake of this study was unknown; awareness of this uptake could help improve drug safety communication. Objective: The aim of this study was to understand how the media present pharmacoepidemiological research using the CNODES isotretinoin study as a case study. Methods: Google News was searched (April 25-May 6, 2016), using a predefined set of terms, for mention of the CNODES study. In total, 26 articles and 3 CNODES publications (original article, press release, and podcast) were identified. The article texts were cleaned (eg, advertisements and links removed), and the podcast was transcribed. A dictionary of 1295 unique words was created using natural language processing (NLP) techniques (term frequency-inverse document frequency, Porter stemming, and stop-word filtering) to identify common words and phrases. Similarity between the articles and reference publications was calculated using Euclidian distance; articles were grouped using hierarchical agglomerative clustering. Nine readability scales were applied to measure text readability based on factors such as number of words, difficult words, syllables, sentence counts, and other textual metrics. Results: The top 5 dictionary words were pregnancy (250 appearances), isotretinoin (220), study (209), drug (201), and women (185). Three distinct clusters were identified: Clusters 2 (5 articles) and 3 (4 articles) were from health-related websites and media, respectively; Cluster 1 (18 articles) contained largely media sources; 2 articles fell outside these clusters. Use of the term isotretinoin versus Accutane (a brand name of isotretinoin), discussion of pregnancy complications, and assignment of responsibility for guideline adherence varied between clusters. For example, the term pregnanc appeared most often in Clusters 1 (14.6 average times per article) and 2 (11.4) and relatively infrequently in Cluster 3 (1.8). Average readability for all articles was high (eg, Flesch-Kincaid, 13; Gunning Fog, 15; SMOG Index, 10; Coleman Liau Index, 15; Linsear Write Index, 13; and Text Standard, 13). Readability increased from Cluster 2 (Gunning Fog of 16.9) to 3 (12.2). It varied between clusters (average 13th-15th grade) but exceeded the recommended health information reading level (grade 6th to 8th), overall. Conclusions: Media interpretation of the CNODES study varied, with differences in synonym usage and areas of focus. All articles were written above the recommended health information reading level. Analyzing media using NLP techniques can help determine drug safety communication effectiveness. This project is important for understanding how drug safety studies are taken up and redistributed in the media. %M 31934872 %R 10.2196/13296 %U https://formative.jmir.org/2020/1/e13296 %U https://doi.org/10.2196/13296 %U http://www.ncbi.nlm.nih.gov/pubmed/31934872 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e16424 %T An Integrated mHealth App for Dengue Reporting and Mapping, Health Communication, and Behavior Modification: Development and Assessment of Mozzify %A Herbuela,Von Ralph Dane Marquez %A Karita,Tomonori %A Francisco,Micanaldo Ernesto %A Watanabe,Kozo %+ Graduate School of Science and Engineering, Ehime University, Bunkyo-cho 3, Matsuyama, Japan, 81 89-927-9847, watanabe_kozo@cee.ehime-u.ac.jp %K dengue fever %K mHealth %K real-time surveillance %K health communication %K behavior modification %D 2020 %7 8.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: For the last 10 years, mobile phones have provided the global health community with innovative and cost-effective strategies to address the challenges in the prevention and management of dengue fever. Objective: The aim is to introduce and describe the design and development process of Mozzify, an integrated mobile health (mHealth) app that features real-time dengue fever case reporting and mapping system, health communication (real-time worldwide news and chat forum/timeline, within-app educational videos, links to local and international health agency websites, interactive signs and symptoms checker, and a hospital directions system), and behavior modification (reminders alert program on the preventive practices against dengue fever). We also aim to assess Mozzify in terms of engagement and information-sharing abilities, functionality, aesthetics, subjective quality, and perceived impact. Methods: The main goals of the Mozzify app were to increase awareness, improve knowledge, and change attitudes about dengue fever, health care-seeking behavior, and intention-to-change behavior on preventive practices for dengue fever among users. It was assessed using the Mobile Application Rating Scale (MARS) among 50 purposively sampled individuals: public health experts (n=5), environment and health-related researchers (n=23), and nonclinical (end users) participants (n=22). Results: High acceptability and excellent satisfaction ratings (mean scores ≥4.0 out of 5) based on the MARS subscales indicate that the app has excellent user design, functionality, usability, engagement, and information among public health experts, environment and health-related researchers, and end users. The app’s subjective quality (recommending the app to other people and the app’s overall star rating), and specific quality (increase awareness, improve knowledge, and change attitudes about dengue fever; health care-seeking behavior; and intention-to-change behavior on preventive practices for dengue fever) also obtained excellent satisfaction ratings from the participants. Some issues and suggestions were raised during the focus group and individual discussions regarding the availability of the app for Android devices, language options limitations, provision of predictive surveillance, and inclusion of other mosquito-borne diseases. Conclusions: Mozzify may be a promising integrated strategic health intervention system for dengue fever case reporting and mapping; increase awareness, improve knowledge, and change attitude about dengue fever; and disseminating and sharing information on dengue fever among the general population and health experts. It also can be an effective aid in the successful translation of knowledge on preventive measures against dengue fever to practice. %M 31913128 %R 10.2196/16424 %U https://formative.jmir.org/2020/1/e16424 %U https://doi.org/10.2196/16424 %U http://www.ncbi.nlm.nih.gov/pubmed/31913128 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e13224 %T A Web-Based Alcohol Risk Communication Tool: Development and Pretesting Study %A Kool,Bridget %A Dobson,Rosie %A Sharpe,Sarah %A Humphrey,Gayl %A Whittaker,Robyn %A Ameratunga,Shanthi %+ School of Population Health, Faculty of Medical and Health Sciences, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand, 64 021524802, b.kool@auckland.ac.nz %K alcohol drinking %K risk assessment %K risk communication %K harm minimization, primary care %D 2020 %7 2.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Alcohol use is a major public health concern associated with an increased risk of morbidity and mortality. Health professionals in primary care commonly see patients with a range of alcohol-related risks and problems, providing an ideal opportunity for screening and brief intervention (BI). Objective: This study aimed to develop a prototype for a Web-based tool for use by primary care health professionals (eg, doctors and nurses) to communicate alcohol harm risk to their patients and to engage with them regarding ways this risk could be reduced. Methods: Following conceptualization and development of prototype wireframes, formative work and pretesting were undertaken. For the formative work, focus groups and key informant interviews were conducted with potential end users of the risk communication tool, including health professionals and consumers. The focus groups and interviews explored perceptions of alcohol risk communication and obtained feedback on the initial prototype. For pretesting, participants (primary care doctors and nurses) completed a Web-based survey followed by a period of pretesting before completion of a follow-up survey. The study was designed to gain feedback on the tool’s performance in real-world settings as well as its relevance, ease of use, and any suggested refinements. Results: In the formative work stage, 11 key informants and 7 consumers participated in either focus groups or individual interviews. Participants were very positive about the prototype and believed that it would be useful and acceptable in practice. Key informants identified that the key point of difference with the tool was that it provided all the pieces in 1 place (ie, assessment, interpretation, and resources to support change). Participants provided feedback on how the tool could be improved, and these suggestions were incorporated into the prototype where possible. In the pretesting stage, 7 people (5 doctors and 2 primary care nurses) completed the pretesting. Participants reported that the tool provided a useful framework for an intervention, that it would be acceptable to patients, that it was easy to use, that they would be likely to use it in practice, and that there were no technical issues. Conclusions: The alcohol risk communication tool was found to be acceptable and has the potential to increase the confidence of health professionals in assessing risk and providing BI. %M 31895043 %R 10.2196/13224 %U https://formative.jmir.org/2020/1/e13224 %U https://doi.org/10.2196/13224 %U http://www.ncbi.nlm.nih.gov/pubmed/31895043 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e15466 %T Understanding End-User Perspectives of Mobile Pulmonary Rehabilitation (mPR): Cross-Sectional Survey and Interviews %A Dobson,Rosie %A Herbst,Pauline %A Candy,Sarah %A Brott,Tamzin %A Garrett,Jeffrey %A Humphrey,Gayl %A Reeve,Julie %A Tawhai,Merryn %A Taylor,Denise %A Warren,Jim %A Whittaker,Robyn %+ National Institute for Health Innovation, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland, 1072, New Zealand, 64 9 3737599, r.dobson@auckland.ac.nz %K mHealth %K rehabilitation %K COPD %D 2019 %7 20.12.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Pulmonary rehabilitation (PR) is an effective intervention for the management of people with chronic respiratory diseases, but the uptake of and adherence to PR programs is low. There is potential for mobile health (mHealth) to provide an alternative modality for the delivery of PR, overcoming many of the barriers contributing to poor attendance to current services. Objective: The objective of this study was to understand the needs, preferences, and priorities of end users for the development of an adaptive mobile PR (mPR) support program. Methods: A mixed methods (qualitative and quantitative) approach was used to assess the needs, preferences, and priorities of the end users (ie, patients with chronic respiratory disorders) and key stakeholders (ie, clinicians working with patients with chronic respiratory disorders and running PR). The formative studies included the following: (1) a survey to understand the preferences and priorities of patients for PR and how mobile technology could be used to provide PR support, (2) ethnographic semistructured interviews with patients with chronic respiratory disorders to gain perspectives on their understanding of their health and potential features that could be included in an mPR program, and (3) key informant interviews with health care providers to understand the needs, preferences, and priorities for the development of an mPR support program. Results: Across all formative studies (patient survey, n=30; patient interviews, n=8; and key stakeholder interviews, n=8), the participants were positive about the idea of an mPR program but raised concerns related to digital literacy and confidence in using technology, access to technology, and loss of social support currently gained from traditional programs. Key stakeholders highlighted the need for patient safety to be maintained and ensuring appropriate programs for different groups within the population. Finding a balance between ensuring safety and maximizing access was seen to be essential in the success of an mPR program. Conclusions: These formative studies found high interest in mHealth-based PR intervention and detailed the potential for an mPR program to overcome current barriers to accessing traditional PR programs. Key considerations and features were identified, including the importance of technology access and digital literacy being considered in utilizing technology with this population. %M 31859681 %R 10.2196/15466 %U http://formative.jmir.org/2019/4/e15466/ %U https://doi.org/10.2196/15466 %U http://www.ncbi.nlm.nih.gov/pubmed/31859681 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e15013 %T Web-Based Module for the Collection of Electronic Patient-Reported Outcomes in People Living With HIV in Nouvelle Aquitaine, France: Usability Evaluation %A Barger,Diana %A Leleux,Olivier %A Conte,Valérie %A Sapparrart,Vincent %A Gapillout,Marie %A Crespel,Isabelle %A Erramouspe,Marie %A Delveaux,Sandrine %A Wittkop,Linda %A Dabis,François %A Bonnet,Fabrice %+ University of Bordeaux, ISPED, Inserm, Bordeaux Population Health Research Center, Team MORPH3EUS, UMR 1219, 146 rue Leo Saignat CS61292, Bordeaux, F-33000, France, 33 0557579291, diana.barger@u-bordeaux.fr %K patient reported outcome measures %K patient generated health data %K quality of life %D 2019 %7 18.12.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient-reported outcomes (PROs) can be of great value for both research and chronic disease management. We developed a new module of the ANRS CO3 Aquitaine cohort study’s Web-based data capture and visualization solution (APPEGE 2.0) for the collection of electronic PROs among people living with HIV cared for in Nouvelle Aquitaine, France. Objective: This study aimed to evaluate the usability of 2 successively developed prototypes of ARPEGE 2.0’s electronic PROs module before launching a pilot study, owing to the novelty of the proposed data collection method for our setting and specific characteristics of the target population. Methods: A total of 2 sequential rounds of empirical, task-based usability evaluations were conducted, involving 8 research staff and then 7 people living with HIV. Evaluators provided written feedback during round 1 and oral feedback during round 2. Evaluators who completed the full set of tasks responded to the System Usability Scale (SUS). We assessed changes in SUS scores between rounds and concluded usability testing when SUS scores reached a ceiling effect, defining good usability a priori as a usability score of 70. Results: Insights were generated regarding the visibility of system status and the match between the system and the real world that improved the module’s usability. Research staff evaluators reported mean SUS scores of 65 (SD 18.87) and patient evaluators reported mean SUS scores of 85 (SD 5.4; P=.032). Conclusions: Software modifications, informed by successive rounds of usability testing, resulted in sufficient gains in usability to undertake piloting. Insights generated during evaluations prompted us to find the appropriate balance between optimal security and ease of use. Trial Registration: ClinicalTrials.gov NCT03296202; https://clinicaltrials.gov/ct2/show/NCT03296202 International Registered Report Identifier (IRRID): RR2-10.2196/10.2196/resprot.9439 %M 31850847 %R 10.2196/15013 %U http://formative.jmir.org/2019/4/e15013/ %U https://doi.org/10.2196/15013 %U http://www.ncbi.nlm.nih.gov/pubmed/31850847 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13854 %T Beliefs Related to Participation in a Large Web-Based Prospective Survey on Diet and Health Among Individuals With a Low Socioeconomic Status: Qualitative Study %A Côté,Mélina %A Lapointe,Annie %A Laramée,Catherine %A Lemieux,Simone %A Desroches,Sophie %A Belanger-Gravel,Ariane %A Lamarche,Benoît %+ Centre Nutrition, Santé, et Société, Institute of Nutrition and Functional Foods, Université Laval, 2440 Hochelaga Boulevard, Québec, QC, G1V 0A6, Canada, 1 418 656 2131 ext 404355, benoit.lamarche@fsaa.ulaval.ca %K focus groups %K qualitative research %K social class %K research subject %K retention %D 2019 %7 10.12.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: NutriQuébec is a Web-based prospective study on the relationship between diet and health as well as the impact of food-related health policies in the adult population of Québec, Canada. Recruitment and retention of individuals with a low socioeconomic status (SES) in such a study are known to be challenging, yet critical for achieving representativeness of the entire population. Objective: This study aimed to identify the behavioral, normative, and control beliefs of individuals with a low SES regarding participation in the NutriQuébec project and to identify their preferences regarding recruitment methods. Methods: A total of four focus groups were conducted in community centers located in low-income areas of Québec City, Canada. On the basis of the theory of planned behavior, participants’ beliefs associated with attitude, subjective norm, and perceived behavioral control regarding hypothetical participation in the NutriQuébec project were identified. Focus groups were recorded, transcribed, and coded by two analysts. Results: Participants (16 men and 12 women) were aged between 28 and 72 years, and a majority of the participants had an annual household income of Can $19,999 or less. The main perceived advantages of participating in the NutriQuébec project were contributing to improved collective health and supporting research. The only disadvantage identified was the risk of having to fill out too many questionnaires. Participants could not, in general, identify persons from their entourage who would approve or disapprove their participation in the study. The main facilitators identified were obtaining a brief health assessment and the ability to complete questionnaires in a way that is not Web-based. The main barrier was the lack of internet access. The preferred means of recruitment were through social media, television, and community centers. Conclusions: These results provide insightful information regarding the best methods and messages to use in order to recruit and retain individuals with a low SES in a population-based prospective study on lifestyle and health on the internet. %M 31821149 %R 10.2196/13854 %U http://formative.jmir.org/2019/4/e13854/ %U https://doi.org/10.2196/13854 %U http://www.ncbi.nlm.nih.gov/pubmed/31821149 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e15000 %T Acceptability and Use of Interactive Voice Response Mobile Phone Surveys for Noncommunicable Disease Behavioral Risk Factor Surveillance in Rural Uganda: Qualitative Study %A Ssemugabo,Charles %A Rutebemberwa,Elizeus %A Kajungu,Dan %A Pariyo,George W %A Hyder,Adnan A %A Gibson,Dustin G %+ Department of Disease Control and Environmental Health, Makerere University School of Public Health, Makerere University College of Health Science, New Mulago Hill Road, Kampala, Uganda, 256 779625182, cssemugabo@gmail.com %K mobile phones %K interactive voice response %K surveillance %K behavioral risk factors %K noncommunicable diseases %K Uganda %D 2019 %7 3.12.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: There is need for more timely data to inform interventions that address the growing noncommunicable disease (NCD) epidemic. With a global increase in mobile phone ownership, mobile phone surveys can bridge this gap. Objective: This study aimed to explore the acceptability and use of interactive voice response (IVR) surveys for surveillance of NCD behavioral risk factors in rural Uganda. Methods: This qualitative study employed user group testing (UGT) with community members. The study was conducted at the Iganga-Mayuge Health and Demographic Surveillance Site (IM-HDSS) in Eastern Uganda. We conducted four UGTs which consisted of different categories of HDSS members: females living in urban areas, males living in urban areas, females living in rural areas, and males living in rural areas. Participants were individually sent an IVR survey, then were brought in for a group discussion using a semistructured guide. Data were analyzed thematically using directed content analysis. Results: Participants perceived that IVR surveys may be useful in promoting confidentiality, saving costs, and raising awareness on NCD behavioral risk factors. Due to the clarity and delivery of questions in the local language, the IVR survey was perceived as easy to use. Community members suggested scheduling surveys on specific days and sending reminders as ways to improve their use for surveillance. Social issues such as domestic violence and perceptions toward unknown calls, technological factors including poor network connections and inability to use phones, and personal issues such as lack of access to phones and use of multiple networks were identified as barriers to the acceptability and use of mobile phone surveys. However, incentives were reported to motivate people to complete the survey. Conclusions: Community members reflected on contextual and sociological implications of using mobile phones for surveillance of NCD behavioral risk factors. The opportunities and challenges that affect acceptability and use of IVR surveys should be considered in designing and implementing surveillance programs for NCD risk factors. %M 31793889 %R 10.2196/15000 %U http://formative.jmir.org/2019/4/e15000/ %U https://doi.org/10.2196/15000 %U http://www.ncbi.nlm.nih.gov/pubmed/31793889 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13728 %T A Behavioral Activation Mobile Health App for Smokers With Depression: Development and Pilot Evaluation in a Single-Arm Trial %A Heffner,Jaimee L %A Watson,Noreen L %A Serfozo,Edit %A Mull,Kristin E %A MacPherson,Laura %A Gasser,Melissa %A Bricker,Jonathan B %+ Public Health Sciences Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, M3-B232, PO Box 19024, Seattle, WA, , United States, 1 206 667 7314, jheffner@fredhutch.org %K tobacco %K nicotine %K smoking cessation %K depression %K smartphone %D 2019 %7 27.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The integration of Behavioral Activation Treatment for Depression (BAT-D) into smoking cessation interventions is a promising approach to address depression as a barrier to quitting. However, this approach has only been tested as a face-to-face intervention, which has low reach. Objective: The aims of the study were to develop a BAT-D mobile health app with high potential reach and determine its feasibility, acceptability, and preliminary effects on theory-based behavioral processes of behavioral activation, reduced depressive symptoms, and smoking cessation. Methods: Following a user-centered design process consisting of competitive analysis, focus groups, and prototype testing, we conducted a single-arm pilot trial of Actify!, a BAT-D app for depressed smokers. Participants used SmokefreeTXT along with Actify! to provide cessation content that had not yet been built into the app for this initial phase of pilot testing. Participants in the trial were current, daily smokers with mild to moderate depressive symptoms. We examined use outcomes for all enrolled participants and process and cessation outcomes at 6 weeks postenrollment for study completers (16/17, 94% retention). Results: Regarding acceptability, average number of log-ins per participant was 16.6 (SD 13.7), and 63% (10/16) reported being satisfied overall with the app. Posttreatment interviews identified some usability challenges (eg, high perceived burden of planning and scheduling values-based activities). There was a significant decrease in depressive symptoms from baseline to follow-up (mean change in Patient Health Questionnaire–9 scores was –4.5, 95% CI –7.7 to –1.3; P=.01). Additionally, carbon monoxide (CO)-confirmed, 7-day point prevalence abstinence (PPA) at 6-week follow-up was 31% (5/16), and the 30-day PPA was 19% (3/16). Conclusions: Results demonstrate promising engagement with Actify! and potential for impact on theory-based change processes and cessation outcomes. Preliminary quit rates compare favorably to previous trials of smoking cessation apps for the general population (ie, short-term, self-reported 30-day quit rates in the 8% to 18% range) and a previous trial of face-to-face BAT-D for depressed smokers (ie, CO-confirmed, 7-day PPA rate of 17% at end of treatment). %M 31774405 %R 10.2196/13728 %U http://formative.jmir.org/2019/4/e13728/ %U https://doi.org/10.2196/13728 %U http://www.ncbi.nlm.nih.gov/pubmed/31774405 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13786 %T A Patient Decision Aid App for Patients With Chronic Kidney Disease: Questionnaire Study %A Therkildsen,Signe Bülow %A Hansen,Linda Houlind %A Jensen,Laura Emilie Dinesen %A Finderup,Jeanette %+ Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 99, Aarhus, 8200, Denmark, 45 78452525, jeajee@rm.dk %K mobile phone %K app %K patient decision aid %K dialysis %K decisional conflict %K usability %D 2019 %7 21.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The Dialysis Guide (DG) is a patient decision aid (PDA) available as an app and developed for mobile phones for patients with chronic kidney disease facing the decision about dialysis modality. Objective: The aim of this study was to uncover the applicability of the DG as a PDA. Methods: The respondents completed a questionnaire before and after using the DG. The respondents' decisional conflicts were examined using the Decisional Conflict Scale, and the usability of the app was examined using the System Usability Scale (SUS). The change in decisional conflict was determined with a paired t test. Results: A total of 22 respondents participated and their mean age was 65.05 years; 20 out of 22 (90%) had attended a patient school for kidney disease, and 13 out of 22 (59%) had participated in a conversation about dialysis choice with a health professional. After using the DG, the respondents' decisional conflicts were reduced, though the reduction was not statistically significant (P=.49). The mean SUS score was 66.82 (SD 14.54), corresponding to low usability. Conclusions: The DG did not significantly reduce decisional conflict, though the results indicate that it helped the respondents decide on dialysis modality. Attending a patient school and having a conversation about dialysis modality choice with a health professional is assumed to have had an impact on the decisional conflict before using the DG. The usability of the DG was not found to be sufficient, which might be caused by the respondents’ average age. Thus, the applicability of the DG cannot be definitively determined. %M 31750836 %R 10.2196/13786 %U http://formative.jmir.org/2019/4/e13786/ %U https://doi.org/10.2196/13786 %U http://www.ncbi.nlm.nih.gov/pubmed/31750836 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e12883 %T The Role of Age, Education, and Digital Health Literacy in the Usability of Internet-Based Cognitive Behavioral Therapy for Chronic Pain: Mixed Methods Study %A van der Vaart,Rosalie %A van Driel,Dorine %A Pronk,Kristel %A Paulussen,Suzan %A te Boekhorst,Selma %A Rosmalen,Judith G M %A Evers,Andrea W M %+ Leiden University, Faculty of Social and Behavioural Sciences, Health, Medical and Neuropsychology Unit, Wassenaarseweg 52, Leiden, Netherlands, 31 071 5276633, r.vandervaart@fsw.leidenuniv.nl %K internet-based cognitive behavior therapy %K chronic pain %K usability %K digital health literacy skills %K eHealth literacy %D 2019 %7 21.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet-based cognitive behavior therapy (iCBT) can be effective in mental and somatic health care. Research on the feasibility of internet interventions in clinical practice is, however, still scarce. Studies with a focus on the patient regarding usability of interventions and digital health literacy skills are especially lacking. Objective: The goal of this study was to assess the usability of an iCBT for chronic pain, Master Your Pain, and the relationship between its usability outcomes and the factors age, educational level, and digital health literacy skills. The aims were to determine what changes were needed in the program for sufficient usability and which individual characteristics were related to the usability of the program. Methods: Patients were recruited from two mental health care practices. A mixed methods approach was used in this study. A qualitative observational study comprising performance tasks in the iCBT program was used to test usability. A quantitative questionnaire was used to measure possible related constructs. Usability was operationalized as the number of tasks that could be completed and the type and number of problems that occurred while doing so. Performance tasks were set up to measure 6 digital skills: (1) operating the computer and internet browser, (2) navigation and orientation, (3) using search strategies, (4) evaluating relevance of content, (5) adding personal content, and (6) protecting and respecting privacy. Participants were asked to think aloud while performing the tasks, and screen activities and webcam recordings were captured. The qualitative observational data was coded using inductive analysis by two independent researchers. Correlational analyses were performed to test how usability relates to sociodemographics and digital health literacy. Results: A total of 32 patients participated, with a mean age of 49.9 years and 84% (27/32) being female. All performance tasks except one (fill in a diary registration) could be completed independently by more than 50% of the participants. On operational, navigation, and search levels, participants struggled most with logging in, logging out, and finding specific parts of the intervention. Half of the sample experienced problems evaluating the relevance and adding content to the program to some extent. Usability correlated moderately negatively with age and moderately positively with digital health literacy skills but not with educational level. Conclusions: The results provide insight into what is essential for proper usability regarding the design of an iCBT program considering variations in age, educational level, and digital health literacy. Furthermore, the results provide insight into what type of support is needed by patients to properly use the intervention. Tailoring support among the needs of certain age groups or skill levels could be beneficial and could range from no extra support (only online feedback, as intended) to practical support (an additional usability introduction session) to blended care (combined face-to-face sessions throughout the therapy). %M 31750839 %R 10.2196/12883 %U http://formative.jmir.org/2019/4/e12883/ %U https://doi.org/10.2196/12883 %U http://www.ncbi.nlm.nih.gov/pubmed/31750839 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e15190 %T Feasibility and Acceptability of an Interactive Mental Well-Being Intervention for People With Intellectual Disabilities: Pilot Mixed Methods Study %A Vereenooghe,Leen %A Westermann,Kristian %+ Faculty of Psychology and Sports Science, Bielefeld University, PO Box 10 01 31, Bielefeld, D-33501, Germany, 49 521106 ext 67521, leen.vereenooghe@uni-bielefeld.de %K intellectual disabilities %K feasibility studies %K tablet computer %K mental health %D 2019 %7 14.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The availability of both digital and traditional mental well-being interventions is rising, but these interventions typically do not consider people with intellectual disabilities as potential users. Objective: The study aimed to explore the acceptability and feasibility of a new digital intervention, developed with and for people with intellectual disabilities, to improve their subjective well-being. Methods: Using a single-group pre-post design, participants with intellectual disabilities and their caregivers completed the 4-week intervention. Mixed methods questionnaires assessed the acceptability of the intervention, in addition to self-report and proxy-report measures of subjective well-being and behavioral problems. Results: A total of 12 men with mild to moderate intellectual disabilities enrolled in and completed the study alongside 8 caregivers. Participant acceptability of the intervention was high, and feedback covered multiple aspects of the intervention, including (1) program concept and design, (2) program content, and (3) intervention usage. Self-rated mood barometers indicated mood improvements for 5 participants, deteriorations for 2 participants, and no observed changes for the remaining participants. Statistical analyses yielded no difference from pretest (median=79; range 39-86) to posttest (median=79; range 21-96) for subjective well-being in people with intellectual disabilities (W=10.5; P=.17) and for behavioral problems (W=14; P=.05). Conclusions: People with intellectual disabilities and their caregivers are receptive to using digital well-being interventions, and this research shows such interventions to be feasible in routine practice. Given the acceptability of the intervention, its potential efficacy can now be evaluated in people with intellectual disabilities and symptoms of reduced mental well-being. %M 31724954 %R 10.2196/15190 %U http://formative.jmir.org/2019/4/e15190/ %U https://doi.org/10.2196/15190 %U http://www.ncbi.nlm.nih.gov/pubmed/31724954 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e14906 %T Formative Evaluation to Build an Online Parenting Skills and Youth Drug Prevention Program: Mixed Methods Study %A Scheier,Lawrence Matthew %A Kumpfer,Karol L %A Brown,Jaynie Litster %A Hu,QingQing %+ LARS Research Institute, 15029 North Thompson Peak Blvd, Suite B111-443, Scottsdale, AZ, 85260, United States, 1 702 630 7584, scheier@larsri.org %K formative evaluation %K parenting skills %K drug prevention %K focus groups %K key stakeholders %K consumer preference survey %K internet intervention %D 2019 %7 5.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Family-based drug prevention programs that use group-based formats with trained facilitators, such as the Strengthening Families Program (SFP), are effective in preventing underage drinking and youth drug use. However, these programs are resource-intensive and have high costs and logistical demands. Tailoring them for Web-based delivery is more cost-effective and makes it easier to scale these programs for widespread dissemination. This requires the active involvement of all key stakeholders to determine content and delivery format. Objective: The aim was to obtain consumer, agency stakeholder, and expert input into the design of a Web-based parenting skills training and youth drug prevention program. Methods: We conducted 10 focus groups with 85 adults (range 4-10, average 8 per group), 20 stakeholder interviews with family services agency staff, and discussed critical design considerations with 10 prevention scientists and e-learning experts to determine the optimal program content and technology features for SFP Online. Focus group participants also answered survey questions on perceived barriers to use, desired navigational features, preferred course format, desired content, preferred reward structures, course length, interactive components, computer efficacy, and technology use. Descriptive statistics were used to examine consumer characteristics; linear regression was used to examine relations between SFP exposure and four continuous outcome measures, including desired program content, interactive technology, and concerns that may inhibit future use of SFP Online. Logistic regression was used as a binary measure of whether consumers desired fun games in the SFP Online program. Results: Three broad thematic categories emerged from the qualitative interviews enumerating the importance of (1) lesson content, (2) logistics for program delivery, and (3) multimedia interactivity. Among the many significant relations, parents who viewed more SFP lessons reported more reasons to use an online program (beta=1.48, P=.03) and also wanted more interactivity (6 lessons: beta=3.72, P=.01; >6 lessons: beta=2.39, P=.01), parents with less interest in a mixed delivery format (class and online) reported fewer reasons to use the online program (beta=−3.93, P=.01), comfort using computers was negatively associated with concerns about the program (beta=−1.83, P=.01), having mobile phone access was related to fewer concerns about online programs (beta=−1.63, P=.02), willingness to view an online program using a mobile phone was positively associated with wanting more online components (beta=1.95, P=.02), and parents who wanted fun games wanted more interactivity (beta=2.28, P=.01). Conclusions: Formative evaluation based on user-centered approaches can provide rich information that fuels development of an online program. The user-centered strategies in this study lay the foundation for improving SFP Online and provide a means to accommodate user interests and ensure the product serves as an effective prevention tool that is attractive to consumers, engaging, and can overcome some of the barriers to recruitment and retention that have previously affected program outcomes in family-based prevention. %M 31687934 %R 10.2196/14906 %U http://formative.jmir.org/2019/4/e14906/ %U https://doi.org/10.2196/14906 %U http://www.ncbi.nlm.nih.gov/pubmed/31687934 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e12966 %T A Mobile Phone App for the Provision of Personalized Food-Based Information in an Eating-Out Situation: Development and Initial Evaluation %A Appleton,Katherine Marie %A Bray,Jeff %A Price,Sarah %A Liebchen,Gernot %A Jiang,Nan %A Mavridis,Ioannis %A Saulais,Laure %A Giboreau,Agnès %A Perez-Cueto,Federico J A %A Coolen,Rebecca %A Ronge,Manfred %A Hartwell,Heather %+ Research Centre for Behaviour Change, Department of Psychology, Faculty of Science and Technology, Bournemouth University, Poole House, Fern Barrow, Poole, BH12 5BB, United Kingdom, 44 1202 965985, k.appleton@bournemouth.ac.uk %K eating %K eating behavior %K food %K diet %K mhealth %K mobile app %K digitalhealth %K smartphone %D 2019 %7 4.11.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Increasing pressure from governments, public health bodies, and consumers is driving a need for increased food-based information provision in eating-out situations. Meals eaten outside the home are known to be less healthy than meals eaten at home, and consumers can complain of poor information on the health impact and allergen content of meals eaten out. Objective: This paper aimed to describe the development and early assessment of a mobile phone app that allows the provision of accurate personalized food-based information while considering individual characteristics (allergies, diet type, and preferences) to enable informed consumer choice when eating out. Methods: An app was designed and developed to address these requirements using an agile approach. The developed app was then evaluated at 8 public engagement events using the System Usability Scale (SUS) questionnaire and qualitative feedback. Results: Consideration of the literature and consultation with consumers revealed a need for information provision for consumers in the eating-out situation, including the ability to limit the information provided to that which was personally relevant or interesting. The app was designed to provide information to consumers on the dishes available in a workplace canteen and to allow consumers the freedom to personalize the app and choose the information that they received. Evaluation using the SUS questionnaire revealed positive responses to the app from a range of potential users, and qualitative comments demonstrated broad interest in its use. Conclusions: This paper details the successful development and early assessment of a novel mobile phone app designed to provide food-based information in an eating-out situation in a personalized manner. %M 31682575 %R 10.2196/12966 %U http://formative.jmir.org/2019/4/e12966/ %U https://doi.org/10.2196/12966 %U http://www.ncbi.nlm.nih.gov/pubmed/31682575 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 6 %N 2 %P e13560 %T Development of a Web-Based Monitoring System for Power Tilt-in-Space Wheelchairs: Formative Evaluation %A Campeau-Vallerand,Charles %A Michaud,François %A Routhier,François %A Archambault,Philippe S %A Létourneau,Dominic %A Gélinas-Bronsard,Dominique %A Auger,Claudine %+ School of Rehabilitation, Faculty of Medicine, Université de Montréal, PO Box 6128 Centre-ville Station, Montreal, QC, H3C 3J7, Canada, 1 514 340 2085 ext 4723, claudine.auger@umontreal.ca %K wheelchairs %K eHealth %K health behavior %K pressure ulcers %K self-help devices %K remote sensing technology %K technology assessment %D 2019 %7 26.10.2019 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: In order to prevent pressure ulcers, wheelchair users are advised to regularly change position to redistribute or eliminate pressure between the buttocks region and the seat of the wheelchair. A power tilt-in-space wheelchair (allowing simultaneous pivoting of the seat and the backrest of the wheelchair toward the back or front) meets many clinical purposes, including pressure management, increased postural control, and pain management. However, there is a significant gap between the use of tilt as recommended by clinicians and its actual usage. A Web-based electronic health (eHealth) intervention, including a goal setting, monitoring, reminder, and feedback system of the use of power tilt-in-space wheelchairs was developed. The intervention incorporates behavior change principles to promote optimal use of tilt and to improve clinical postprocurement follow-up. Objective: This study aimed to conduct a formative evaluation of the intervention prototype to pinpoint the functionalities needed by end users, namely, power wheelchair users and clinicians. Methods: On the basis of an evaluation framework for Web-based eHealth interventions, semistructured interviews were conducted with power wheelchair users and clinicians. A content analysis was performed with a mix of emerging and a priori concepts. Results: A total of 5 users of power tilt-in-space wheelchairs and 5 clinicians who had experience in the field of mobility aids aged 23 to 55 years were recruited. Participants found the Web interface and the physical components easy to use. They also appreciated the reminder feature that encourages the use of the tilt-in-space and the customization of performance goals. Participants requested improvements to the visual design and learnability of the Web interface, the customization of reminders, feedback about specific tilt parameters, and the bidirectionality of the interaction between the user and the clinician. They thought the current version of the intervention prototype could promote optimal use of the tilt and improve clinical postprocurement follow-up. Conclusions: On the basis of the needs identified by power wheelchair users and clinicians regarding the prototype of a power tilt-in-space wheelchair monitoring system, 3 main directions were defined for future development of the intervention. Further research with new wheelchair users, manual tilt-in-space wheelchairs, various age groups, and family caregivers is recommended to continue the formative evaluation of the prototype. %M 31674918 %R 10.2196/13560 %U https://rehab.jmir.org/2019/2/e13560 %U https://doi.org/10.2196/13560 %U http://www.ncbi.nlm.nih.gov/pubmed/31674918 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e14327 %T Web-Based Health Information Seeking Among Students at Kuwait University: Cross-Sectional Survey Study %A Ashkanani,Hasan %A Asery,Rabab %A Bokubar,Fajer %A AlAli,Noor %A Mubarak,Shahad %A Buabbas,Ali %A Almajran,Abdullah %+ Faculty of Medicine, Kuwait University, Block 4, Fourth Ring Road, Health Sciences Center, Jabriyah, Kuwait, 965 246 36559, hasanashkanani@hotmail.com %K Kuwait %K online %K health care %D 2019 %7 31.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Owing to the revolution in technology, the internet has become an important aspect of people’s lives. Modern technology is enabling people from diverse educational backgrounds to use the internet for several purposes, one of which is health information seeking. Recently, Web-based health information has become more popular among patients all over the world and among the general public. Objective: This study aimed to investigate the use of Web-based health resources among undergraduate students from different faculties at Kuwait University. Methods: The study employed a cross-sectional design with students selected from 8 faculties of Kuwait University, 4 faculties of Literature and 4 faculties of Science. Data were collected using structured questionnaires, and analysis was done using a chi-square test and binary logistic regression to determine the factors associated with seeking health information on the Web. Results: The sample size obtained was 1132 with a response rate of 90.27% (1132/1254). Overall, the prevalence of students seeking Web-based health information was 92.66%. (1049/1132) The most significant factors associated with seeking health information on the Web were age, gender, faculty, year of study, primary source of internet, and level of experience with internet use. In total, 90.0% (325/361) of students who were aged older than 21 years used Web-based health information compared with 82.8% (275/332) of those who were aged 18 years. In addition, female students showed a higher prevalence (829/934, 88.8%) of Web-based health information seeking than males (210/270, 77.8%). Students who majored in faculties of Science were more likely to seek health information than those who majored in faculties of Literature. All the differences found in the study were statistically significant (P<.05). Conclusions: The study concluded that many people use the internet for seeking health information. Sociodemographic factors have a significant association with Web-based health information seeking. Therefore, doctors must educate the public about the health information websites that can be trusted. %M 31473592 %R 10.2196/14327 %U http://formative.jmir.org/2019/4/e14327/ %U https://doi.org/10.2196/14327 %U http://www.ncbi.nlm.nih.gov/pubmed/31473592 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e11266 %T Virtual Reality as a Therapy Adjunct for Fear of Movement in Veterans With Chronic Pain: Single-Arm Feasibility Study %A Fowler,Christopher A %A Ballistrea,Lisa M %A Mazzone,Kerry E %A Martin,Aaron M %A Kaplan,Howard %A Kip,Kevin E %A Ralston,Katherine %A Murphy,Jennifer L %A Winkler,Sandra L %+ Research and Development Service, James A Haley Veterans Hospital, 8900 Grand Oak Circle, Tampa, FL, 33705, United States, 1 813 558 3904, christopher.fowler3@va.gov %K chronic pain %K virtual reality %K Veterans %K pain management %K rehabilitation %K fear of movement %K kinesiophobia %K exposure therapy %K distraction therapy %D 2019 %7 30.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Virtual reality (VR) has demonstrated efficacy for distraction from pain-related thoughts and exposure to feared movements. Little empirical VR research has focused on chronic pain management. Objective: The purpose of this study was to examine the feasibility of VR as an adjunctive intervention for Veterans with chronic pain. We designed a hierarchy ranging from low-intensity pain distraction to high-intensity movement-based exposure for this purpose. VR apps were mapped onto the hierarchy. Methods: Sixteen Veterans receiving inpatient chronic pain rehabilitation participated in daily VR sessions over a 3-week period. Trajectories across the distraction-to-exposure hierarchy and Veteran-reported intensity ratings were described and evaluated over time. Minimum clinically important differences (MCIDs), pre-post effect sizes, and 95% confidence intervals were examined for fear of movement using the Fear of Daily Activities Questionnaire (FDAQ) and Pain Outcomes Questionnaire-VA (POQ-VA; fear scale). This approach was applied to secondary outcomes: POQ-VA (pain intensity, interference, negative affect), Pain Catastrophizing Scale, and Patient-Specific Functioning Scale (PSFS). Session attendance, completion, and VR experiences were described. Results: Ten of 14 Veterans (71%) who participated in three or more VR sessions completed the distraction-to-exposure hierarchy. Only three trajectories emerged more than once. Due to high completion rates, Veterans that completed the hierarchy could self-select nonhierarchy apps. Veterans rated all hierarchy levels (low, medium, high) near medium intensity. Self-selected activities were rated as high intensity. For kinesiophobia, six Veterans (38%) exceeded the MCID on the FDAQ and a small effect size improvement was observed (Cohen d=−0.35). The confidence interval (95% CI −0.71 to 0.01) indicated the possibility of a null effect. The POQ-VA fear scale yielded no effect (Cohen d=0.06, 95% CI −0.43 to 0.54). For secondary outcomes, Veterans exceeding MCID were calculated with complete data: pain intensity (1/15, 7%), pain catastrophizing (5/14, 36%), and patient-specific functioning (10/15, 67%). Effect sizes were large for patient-specific functioning (Cohen d=1.14, 95% CI 0.50-1.78), medium for mobility interference (Cohen d=−0.56, 95% CI −0.96 to −0.16), and small for pain intensity (Cohen d=−0.40, 95% CI −0.69 to −0.12) and catastrophizing (Cohen d=−0.41, 95% CI −0.79 to −0.02). No effects were observed for interference in daily activities (Cohen d=0.10, 95% CI −0.27 to 0.47) and negative affect (Cohen d=0.07, 95% CI −0.26 to 0.40). Veterans attended 85.2% (98/108) of VR sessions and completed 95% (93/96) of sessions attended. Twenty-minute sessions were rated as too short. No significant adverse events were reported. Conclusions: Findings support the feasibility of VR as an adjunct for Veterans with chronic pain. However, the hierarchy will require modification, as evidenced by homogeneous intensity ratings. Veteran-selected activities presented the highest intensity ratings, largest outcome effect size (PSFS), and MCID. This highlights the important role of utilizing Veteran stakeholders in hierarchy modification, design of VR interventions, and outcome selection. %M 31670696 %R 10.2196/11266 %U http://formative.jmir.org/2019/4/e11266/ %U https://doi.org/10.2196/11266 %U http://www.ncbi.nlm.nih.gov/pubmed/31670696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13863 %T Accuracy of a Chatbot (Ada) in the Diagnosis of Mental Disorders: Comparative Case Study With Lay and Expert Users %A Jungmann,Stefanie Maria %A Klan,Timo %A Kuhn,Sebastian %A Jungmann,Florian %+ Department of Psychology, Johannes Gutenberg-University Mainz, Wallstraße 3, Mainz, 55122, Germany, 49 61313939201, jungmann@uni-mainz.de %K artificial intelligence %K eHealth %K mental disorders %K mHealth %K screening %K (mobile) app %K diagnostic %D 2019 %7 29.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Health apps for the screening and diagnosis of mental disorders have emerged in recent years on various levels (eg, patients, practitioners, and public health system). However, the diagnostic quality of these apps has not been (sufficiently) tested so far. Objective: The objective of this pilot study was to investigate the diagnostic quality of a health app for a broad spectrum of mental disorders and its dependency on expert knowledge. Methods: Two psychotherapists, two psychology students, and two laypersons each read 20 case vignettes with a broad spectrum of mental disorders. They used a health app (Ada—Your Health Guide) to get a diagnosis by entering the symptoms. Interrater reliabilities were computed between the diagnoses of the case vignettes and the results of the app for each user group. Results: Overall, there was a moderate diagnostic agreement (kappa=0.64) between the results of the app and the case vignettes for mental disorders in adulthood and a low diagnostic agreement (kappa=0.40) for mental disorders in childhood and adolescence. When psychotherapists applied the app, there was a good diagnostic agreement (kappa=0.78) regarding mental disorders in adulthood. The diagnostic agreement was moderate (kappa=0.55/0.60) for students and laypersons. For mental disorders in childhood and adolescence, a moderate diagnostic quality was found when psychotherapists (kappa=0.53) and students (kappa=0.41) used the app, whereas the quality was low for laypersons (kappa=0.29). On average, the app required 34 questions to be answered and 7 min to complete. Conclusions: The health app investigated here can represent an efficient diagnostic screening or help function for mental disorders in adulthood and has the potential to support especially diagnosticians in their work in various ways. The results of this pilot study provide a first indication that the diagnostic accuracy is user dependent and improvements in the app are needed especially for mental disorders in childhood and adolescence. %M 31663858 %R 10.2196/13863 %U http://formative.jmir.org/2019/4/e13863/ %U https://doi.org/10.2196/13863 %U http://www.ncbi.nlm.nih.gov/pubmed/31663858 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13013 %T A Promising Food-Coaching Intervention Program to Achieve Optimal Gestational Weight Gain in Overweight and Obese Pregnant Women: Pilot Randomized Controlled Trial of a Smartphone App %A Li,Ling-Jun %A Aris,Izzuddin M %A Han,Wee Meng %A Tan,Kok Hian %+ Department of Obstetrics & Gynecology, KK Women's and Children's Hospital, 100 Bukit Timah Road, Children's Tower Level 3, Singapore, 229899, Singapore, 65 63941099, queenie.li.l.j@gmail.com %K overweight, obesity, pregnant women %K gestational weight gain %K food diary %K randomized controlled trial %K smartphone app %K food coaching %K dietary recommendation %K feasibility %D 2019 %7 24.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Traditional dietary recommendations for achieving optimal gestational weight gain are ineffective for pregnant women due to the lack of real-time communication and tedious consultation processes. Objective: In this pilot study, we aimed to determine the feasibility of a novel food-coaching smartphone app for controlling gestational weight gain and macronutrient intake among overweight and obese pregnant women. Methods: We designed a randomized controlled trial and recruited 30 overweight and obese pregnant women (1:1 ratio) during 18-20 weeks of gestation and followed them up after 4 and 8 weeks, respectively. Both groups received standard pregnancy dietary orientation at recruitment, while the intervention group received 8 weeks of real-time food coaching via a smartphone app. This food-coaching smartphone app (Glycoleap, Holmusk, Singapore) aimed to improve care and outcomes for people with diabetes. Pregnant women using this app were able to upload food images (eg, a picture of a meal, a drink, or a dessert) and received real-time and detailed food-coaching comments and guidance provided by professional dietitians during the day (8 AM to 8 PM). We recorded detailed characteristics during recruitment and examined anthropometry at all visits. We compared the mean differences of the 8-week gestational weight gain and macronutrient intake between the two groups. Results: Upon study completion, three subjects dropped out from the intervention, and one gave birth prematurely in the control group. The acceptance rate of the smartphone app was 90%. More participants achieved optimal gestational weight gain per week in the intervention group (8/12, 67%) than in the control group (5/14, 36%). After the 8-week intervention, women in the intervention group appeared to have lower gestational weight gain (mean difference=–0.08 kg; 95% CI –1.80 to 1.63) and cholesterol intake (mean difference=–31.73 mg; 95% CI –102.91 to 39.45) than those in the control group. Conclusions: Our findings showed that this food-coaching smartphone app is feasible and favorable for weight gain control and cholesterol intake control among overweight and obese pregnant women. Although our results were not significant (perhaps, attributed to the small sample size), it provided proof of concept for the feasibility of applying such technology in future randomized controlled trials with a larger sample size, an earlier intervention onset, and a longer follow-up for overweight and obese pregnant women. %M 31651407 %R 10.2196/13013 %U http://formative.jmir.org/2019/4/e13013/ %U https://doi.org/10.2196/13013 %U http://www.ncbi.nlm.nih.gov/pubmed/31651407 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e15738 %T Internet-Based Cognitive Behavioral Therapy via Videoconference for Patients With Bulimia Nervosa and Binge-Eating Disorder: Pilot Prospective Single-Arm Feasibility Trial %A Hamatani,Sayo %A Numata,Noriko %A Matsumoto,Kazuki %A Sutoh,Chihiro %A Ibuki,Hanae %A Oshiro,Keiko %A Tanaka,Mari %A Setsu,Rikukage %A Kawasaki,Yohei %A Hirano,Yoshiyuki %A Shimizu,Eiji %+ Research Center for Child Mental Development, Chiba University, 1-8-1, Chuo-ku, Chiba, Japan, 81 43 226 207, n_numata@chiba-u.jp %K bulimia nervosa %K binge-eating disorder %K cognitive behavioral therapy %K internet-based cognitive behavioral therapy %K videoconference %D 2019 %7 23.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: A major problem in providing mental health services is the lack of access to treatment, especially in remote areas. Thus far, no clinical studies have demonstrated the feasibility of internet-based cognitive behavioral therapy (ICBT) with real-time therapist support via videoconference for bulimia nervosa and binge-eating disorder in Japan. Objective: The goal of the research was to evaluate the feasibility of ICBT via videoconference for patients with bulimia nervosa or binge-eating disorder. Methods: Seven Japanese subjects (mean age 31.9 [SD 7.9] years) with bulimia nervosa and binge-eating disorder received 16 weekly sessions of individualized ICBT via videoconference with real-time therapist support. Treatment included CBT tailored specifically to the presenting diagnosis. The primary outcome was a reduction in the Eating Disorder Examination Edition 16.0D (EDE 16D) for bulimia nervosa and binge-eating disorder: the combined objective binge and purging episodes, objective binge episodes, and purging episodes. The secondary outcomes were the Eating Disorders Examination Questionnaire, Bulimic Investigatory Test, Edinburgh, body mass index for eating symptoms, Motivational Ruler for motivation to change, EuroQol-5 Dimension for quality of life, 9-item Patient Health Questionnaire for depression, 7-item Generalized Anxiety Disorder scale for anxiety, and Working Alliance Inventory–Short Form (WAI-SF). All outcomes were assessed at week 1 (baseline) and weeks 8 (midintervention) and 16 (postintervention) during therapy. Patients were asked about adverse events at each session. For the primary analysis, treatment-related changes were assessed by comparing participant scores and 95% confidence intervals using the paired t test. Results: Although the mean combined objective binge and purging episodes improved from 47.60 to 13.60 (71% reduction) and showed a medium effect size (Cohen d=–0.76), there was no significant reduction in the combined episodes (EDE 16D –41; 95% CI –2.089 to 0.576; P=.17). There were no significant treatment-related changes in secondary outcomes. The WAI-SF scores remained consistently high (64.8 to 66.0) during treatment. Conclusions: ICBT via videoconference is feasible in Japanese patients with bulimia nervosa and binge-eating disorder. Trial Registration: UMIN Clinical Trials Registry UMIN000029426; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000033419 %M 31647472 %R 10.2196/15738 %U http://formative.jmir.org/2019/4/e15738/ %U https://doi.org/10.2196/15738 %U http://www.ncbi.nlm.nih.gov/pubmed/31647472 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13286 %T Passive Monitoring of Short-Acting Beta-Agonist Use via Digital Platform in Patients With Chronic Obstructive Pulmonary Disease: Quality Improvement Retrospective Analysis %A Chen,Jessica %A Kaye,Leanne %A Tuffli,Michael %A Barrett,Meredith A %A Jones-Ford,Shelanda %A Shenouda,Tina %A Gondalia,Rahul %A Henderson,Kelly %A Combs,Veronica %A Van Sickle,David %A Stempel,David A %+ Propeller Health, 47 Maiden Lane, 3rd Floor, San Francisco, CA, United States, 1 608 251 0470, leanne.kaye@propellerhealth.com %K chronic obstructive pulmonary disease %K telemedicine %K quality improvement, feasibility %K nebulizers and vaporizers %K health services %D 2019 %7 23.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health programs assist patients with chronic obstructive pulmonary disease (COPD) to better manage their disease. Technological and adoption barriers have been perceived as a limitation. Objective: The aim of the research was to evaluate a digital quality improvement pilot in Medicare-eligible patients with COPD. Methods: COPD patients were enrolled in a digital platform to help manage their medications and symptoms as part of their routine clinical care. Patients were provided with electronic medication monitors (EMMs) to monitor short-acting beta-agonist (SABA) use passively and a smartphone app to track use trends and receive feedback. Providers also had access to data collected via a secure website and were sent email notifications if a patient had a significant change in their prescribed inhaler use. Providers then determined if follow-up was needed. Change in SABA use and feasibility outcomes were evaluated at 3, 6, and 12 months. Results: A total of 190 patients enrolled in the pilot. At 3, 6, and 12 months, patients recorded significant reductions in daily and nighttime SABA use and increases in SABA-free days (all P<.001). Patient engagement, as measured by the ratio of daily active use to monthly active use, was >90% at both 6 and 12 months. Retention at 6 months was 81% (154/190). Providers were sent on average two email notifications per patient during the 12-month program. Conclusions: A digital health program integrated as part of standard clinical practice was feasible and had low provider burden. The pilot demonstrated significant reduction in SABA use and increased SABA-free days among Medicare-eligible COPD patients. Further, patients readily adopted the digital platform and demonstrated strong engagement and retention rates at 6 and 12 months. %M 31647471 %R 10.2196/13286 %U http://formative.jmir.org/2019/4/e13286/ %U https://doi.org/10.2196/13286 %U http://www.ncbi.nlm.nih.gov/pubmed/31647471 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e12346 %T Adapting Mobile and Wearable Technology to Provide Support and Monitoring in Rehabilitation for Dementia: Feasibility Case Series %A Thorpe,Julia %A Forchhammer,Birgitte Hysse %A Maier,Anja M %+ Engineering Systems Design, DTU Management, Technical University of Denmark, Diplomvej, Building 317, Kongens Lyngby, 2800, Denmark, 45 45256045, amai@dtu.dk %K dementia %K cognitive rehabilitation %K mobility %K activity %K mHealth %K uHealth %K pervasive health care %K P4 health care %K health care design %D 2019 %7 17.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile and wearable devices are increasingly being used to support our everyday lives and track our behavior. Since daily support and behavior tracking are two core components of cognitive rehabilitation, such personal devices could be employed in rehabilitation approaches aimed at improving independence and engagement among people with dementia. Objective: The aim of this work was to investigate the feasibility of using smartphones and smartwatches to augment rehabilitation by providing adaptable, personalized support and objective, continuous measures of mobility and activity behavior. Methods: A feasibility study comprising 6 in-depth case studies was carried out among people with early-stage dementia and their caregivers. Participants used a smartphone and smartwatch for 8 weeks for personalized support and followed goals for quality of life. Data were collected from device sensors and logs, mobile self-reports, assessments, weekly phone calls, and interviews. This data were analyzed to evaluate the utility of sensor data generated by devices used by people with dementia in an everyday life context; this was done to compare objective measures with subjective reports of mobility and activity and to examine technology acceptance focusing on usefulness and health efficacy. Results: Adequate sensor data was generated to reveal behavioral patterns, even for minimal device use. Objective mobility and activity measures reflecting fluctuations in participants’ self-reported behavior, especially when combined, may be advantageous in revealing gradual trends and could provide detailed insights regarding goal attainment ratings. Personalized support benefited all participants to varying degrees by addressing functional, memory, safety, and psychosocial needs. A total of 4 of 6 (67%) participants felt motivated to be active by tracking their step count. One participant described a highly positive impact on mobility, anxiety, mood, and caregiver burden, mainly as a result of navigation support and location-tracking tools. Conclusions: Smartphones and wearables could provide beneficial and pervasive support and monitoring for rehabilitation among people with dementia. These results substantiate the need for further investigation on a larger scale, especially considering the inevitable presence of mobile and wearable technology in our everyday lives for years to come. %M 31625951 %R 10.2196/12346 %U http://formative.jmir.org/2019/4/e12346/ %U https://doi.org/10.2196/12346 %U http://www.ncbi.nlm.nih.gov/pubmed/31625951 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e14052 %T Understanding Health Behavior Technology Engagement: Pathway to Measuring Digital Behavior Change Interventions %A Cole-Lewis,Heather %A Ezeanochie,Nnamdi %A Turgiss,Jennifer %+ Johnson and Johnson Health and Wellness Solutions, Inc, 1 Johnson and Johnson Plaza, New Brunswick, NJ, 08933, United States, 1 7209330786, nezeanoc@its.jnj.com %K engagement %K user engagement %K health behavior %K health determinants %K digital behavior change intervention %K measurements %D 2019 %7 10.10.2019 %9 Viewpoint %J JMIR Form Res %G English %X Researchers and practitioners of digital behavior change interventions (DBCI) use varying and, often, incongruent definitions of the term “engagement,” thus leading to a lack of precision in DBCI measurement and evaluation. The objective of this paper is to propose discrete definitions for various types of user engagement and to explain why precision in the measurement of these engagement types is integral to ensuring the intervention is effective for health behavior modulation. Additionally, this paper presents a framework and practical steps for how engagement can be measured in practice and used to inform DBCI design and evaluation. The key purpose of a DBCI is to influence change in a target health behavior of a user, which may ultimately improve a health outcome. Using available literature and practice-based knowledge of DBCI, the framework conceptualizes two primary categories of engagement that must be measured in DBCI. The categories are health behavior engagement, referred to as “Big E,” and DBCI engagement, referred to as “Little e.” DBCI engagement is further bifurcated into two subclasses: (1) user interactions with features of the intervention designed to encourage frequency of use (ie, simple login, games, and social interactions) and make the user experience appealing, and (2) user interactions with behavior change intervention components (ie, behavior change techniques), which influence determinants of health behavior and subsequently influence health behavior. Achievement of Big E in an intervention delivered via digital means is contingent upon Little e. If users do not interact with DBCI features and enjoy the user experience, exposure to behavior change intervention components will be limited and less likely to influence the behavioral determinants that lead to health behavior engagement (Big E). Big E is also dependent upon the quality and relevance of the behavior change intervention components within the solution. Therefore, the combination of user interactions and behavior change intervention components creates Little e, which is, in turn, designed to improve Big E. The proposed framework includes a model to support measurement of DBCI that describes categories of engagement and details how features of Little e produce Big E. This framework can be applied to DBCI to support various health behaviors and outcomes and can be utilized to identify gaps in intervention efficacy and effectiveness. %M 31603427 %R 10.2196/14052 %U https://formative.jmir.org/2019/4/e14052 %U https://doi.org/10.2196/14052 %U http://www.ncbi.nlm.nih.gov/pubmed/31603427 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e14493 %T Development of a Digital Decision Support Tool to Aid Participation of Children With Disabilities in Pediatric Rehabilitation Services: Explorative Qualitative Study %A Vinblad,Elin %A Larsson,Ingrid %A Lönn,Maria %A Olsson,Emma %A Nygren,Jens M %A Svedberg,Petra %+ School of Health and Welfare, Halmstad University, Box 823, Halmstad, S-30118, Sweden, 46 35167693, petra.svedberg@hh.se %K child %K child care %K decision making %K eHealth %K disabled children %K patient participation %K rehabilitation %K qualitative research %D 2019 %7 2.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Building a health care system in accordance with the rule of law requires child-centered care, where children and young people, regardless of ability, are allowed to participate in visits with their health care professionals. As part of an overall project focusing on developing and implementing a digital decision support tool to increase the participation of children with disabilities in pediatric rehabilitation, this study brings new knowledge as to how this specific patient group views participation. Objective: The aim of this formative study was to explore the experiences of children and young people with disabilities concerning increasing their participation in the pediatric rehabilitation services. Methods: The formative study had an explorative design, based on a latent qualitative content analysis with an inductive approach. Interviews were conducted with 20 children (6-17 years) and 8 young people (19-30 years) with disabilities about their experiences of participation in pediatric rehabilitation services. Results: A total of 3 categories emerged reflecting the participants’ possibilities of participation in the pediatric rehabilitation services: to feel involved, to feel independent, and to work in partnership. To feel involved meant being listened to and being connected, to feel independent meant being admitted and being enabled, and to work in partnership meant being supported and being able to entrust others with the decision making. With the overall theme moving toward empowerment of children in pediatric rehabilitation, a true feeling of participation can be experienced. Conclusions: The views of children and young people with disabilities are that children should be given the prerequisites for empowerment by being allowed to feel involved and independent as well as to work in partnership to experience true participation in the pediatric rehabilitation services. This finding is essential in the design of a digital decision support tool based on the children’s needs and perspectives. %M 31579015 %R 10.2196/14493 %U https://formative.jmir.org/2019/4/e14493 %U https://doi.org/10.2196/14493 %U http://www.ncbi.nlm.nih.gov/pubmed/31579015 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13610 %T Use of Patient-Reported Data to Match Depression Screening Intervals With Depression Risk Profiles in Primary Care Patients With Diabetes: Development and Validation of Prediction Models for Major Depression %A Jin,Haomiao %A Wu,Shinyi %+ Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 S Olive St, Suite 1400, Los Angeles, CA, 90015, United States, 1 213 821 6441, haomiaoj@usc.edu %K patient-reported data %K patient-centered decision making %K depression screening %K depression %K diabetes %K health information technology %K data analytics %K predictive modeling %K machine learning %K data mining %D 2019 %7 1.10.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinical guidelines recommend screening for depression in the general adult population but recognizes that the optimum interval for screening is unknown. Ideal screening intervals should match the patient risk profiles. Objective: This study describes a predictive analytics approach for mining clinical and patient-reported data from a large clinical study for the identification of primary care patients at high risk for depression to match depression screening intervals with patient risk profiles. Methods: This paper analyzed data from a large safety-net primary care study for diabetes and depression. A regression-based data mining technique was used to examine 53 demographics, clinical variables, and patient-reported variables to develop three prediction models for major depression at 6, 12, and 18 months from baseline. Predictors with the strongest predictive power that require low information collection efforts were selected to develop the prediction models. Predictive accuracy was measured by the area under the receiver operating curve (AUROC) and was evaluated by 10-fold cross-validation. The effectiveness of the prediction algorithms in supporting clinical decision making for six “typical” types of patients was demonstrated. Results: The analysis included 923 patients who were nondepressed at the study baseline. Five patient-reported variables were selected in the prediction models to predict major depression at 6, 12, and 18 months: (1) Patient Health Questionnaire 2-item score; (2) the Sheehan Disability Scale; (3) previous problems with depression; (4) the diabetes symptoms scale; and (5) emotional burden of diabetes. All three depression prediction models had an AUROC>0.80, comparable with published depression prediction studies. Among the 6 “typical” types of patients, the algorithms suggest that patients who reported impaired daily functioning by health status are at an elevated risk for depression in all three periods. Conclusions: This study demonstrated that leveraging patient-reported data and prediction models can help improve identification of high-risk patients and clinical decisions about the depression screening interval for diabetes patients. Implementation of this approach can be coupled with application of modern technologies such as telehealth and mobile health assessment for collecting patient-reported data to improve privacy, reducing stigma and costs, and promoting a personalized depression screening that matches screening intervals with patient risk profiles. %M 31573900 %R 10.2196/13610 %U https://formative.jmir.org/2019/4/e13610 %U https://doi.org/10.2196/13610 %U http://www.ncbi.nlm.nih.gov/pubmed/31573900 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e12852 %T Using a Mobile Diary App in the Treatment of Borderline Personality Disorder: Mixed Methods Feasibility Study %A Helweg-Joergensen,Stig %A Schmidt,Thomas %A Lichtenstein,Mia Beck %A Pedersen,Susanne S %+ Department of Psychology, University of Southern Denmark, Campusvej 55, Odense, 5230, Denmark, 45 6550 2740, stighj@rsyd.dk %K borderline personality disorder %K mHealth %K implementation %K focus groups %K e-diary %K mobile app %D 2019 %7 30.9.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Borderline personality disorder (BPD) is a disorder characterized by difficulties with regulating emotions and impulsive behavior. Long-term monitoring of progress during BPD psychotherapy constitutes a challenge using paper and pencil registration. Hence, a mobile app assessing emotions and progress in treatment may be useful. Objective: The aim of this study was to examine the feasibility of using the mDiary app as an adjunct to dialectical behavior therapy (DBT) for the treatment of BPD. Methods: A total of 9 focus group interviews were conducted and analyzed according to the grounded theory approach. Furthermore, the usability of the mDiary app was examined using the System Usability Scale (SUS). The app was implemented in a standard DBT program as an adjunct to DBT. In total, 16 patients (age range 19-41 years) and 23 therapists (age range 25-64 years) from 5 Danish public outpatient psychiatric treatment facilities participated in the study. Results: Overall, patients were satisfied with the mDiary app, as it was “easy to use” and “always there.” Inside-out innovation, meaning new work tasks generated during implementation and communication of modifications needed in the app, was found to influence the perceived usability negatively among the interviewed therapists. The patients rated the usability as high (mean SUS score 81.2, SD 9.9), whereas therapists rated the mDiary app at an average level (mean 68.3, SD 14.3). Older age of the users correlated with lower usability ratings on the SUS score (Pearson r=−0.60). Conclusions: The mDiary app was considered as an acceptable and relevant way of registering DBT diary data for both patients and therapists generating increased long-term overview. Older users were overall more reluctant to accept this new technology in clinical practice. Time to align expectations among involved parties needs to be set aside when implementing this new approach to patient monitoring. Here, the focus should be on the realistic use of resources and expected impact on present clinical work. %M 31573910 %R 10.2196/12852 %U http://formative.jmir.org/2019/3/e12852/ %U https://doi.org/10.2196/12852 %U http://www.ncbi.nlm.nih.gov/pubmed/31573910 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e11617 %T A Mobile Patient-Reported Outcome Measure App With Talking Touchscreen: Usability Assessment %A Welbie,Marlies %A Wittink,Harriet %A Westerman,Marjan J %A Topper,Ilse %A Snoei,Josca %A Devillé,Walter L J M %+ Research Group Lifestyle and Health, Research Center Healthy and Sustainable Living, Utrecht University of Applied Sciences, Postbus 12011, Utrecht, 3501 AA, Netherlands, 31 638192100, marlies.welbie@hu.nl %K mHealth %K eHealth %K surveys and questionnaires %K physical therapy specialty %K qualitative research %D 2019 %7 27.9.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: In the past years, a mobile health (mHealth) app called the Dutch Talking Touch Screen Questionnaire (DTTSQ) was developed in The Netherlands. The aim of development was to enable Dutch physical therapy patients to autonomously complete a health-related questionnaire regardless of their level of literacy and digital skills. Objective: The aim of this study was to evaluate the usability (defined as the effectiveness, efficiency, and satisfaction) of the prototype of the DTTSQ for Dutch physical therapy patients with diverse levels of experience in using mobile technology. Methods: The qualitative Three-Step Test-Interview method, including both think-aloud and retrospective probing techniques, was used to gain insight into the usability of the DTTSQ. A total of 24 physical therapy patients were included. The interview data were analyzed using a thematic content analysis approach aimed at analyzing the accuracy and completeness with which participants completed the questionnaire (effectiveness), the time it took the participants to complete the questionnaire (efficiency), and the extent to which the participants were satisfied with the ease of use of the questionnaire (satisfaction). The problems encountered by the participants in this study were given a severity rating that was used to provide a rough estimate of the need for additional usability efforts. Results: All participants within this study were very satisfied with the ease of use of the DTTSQ. Overall, 9 participants stated that the usability of the app exceeded their expectations. The group of 4 average-/high-experienced participants encountered only 1 problem in total, whereas the 11 little-experienced participants encountered an average of 2 problems per person and the 9 inexperienced participants an average of 3 problems per person. A total of 13 different kind of problems were found during this study. Of these problems, 4 need to be addressed before the DTTSQ will be released because they have the potential to negatively influence future usage of the tool. The other 9 problems were less likely to influence future usage of the tool substantially. Conclusions: The usability of the DTTSQ needs to be improved before it can be released. No problems were found with satisfaction or efficiency during the usability test. The effectiveness needs to be improved by (1) making it easier to navigate through screens without the possibility of accidentally skipping one, (2) enabling the possibility to insert an answer by tapping on the text underneath a photograph instead of just touching the photograph itself, and (3) making it easier to correct wrong answers. This study shows the importance of including less skilled participants in a usability study when striving for inclusive design and the importance of measuring not just satisfaction but also efficiency and effectiveness during such studies. %M 31573909 %R 10.2196/11617 %U https://formative.jmir.org/2019/3/e11617 %U https://doi.org/10.2196/11617 %U http://www.ncbi.nlm.nih.gov/pubmed/31573909 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13662 %T Technology-Enabled Mental Health Service Reform for Open Arms – Veterans and Families Counselling: Participatory Design Study %A LaMonica,Haley M %A Davenport,Tracey A %A Burns,Jane %A Cross,Shane %A Hodson,Stephanie %A Veitch,Jennifer %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, 2050, Australia, 61 286276939, haley.lamonica@sydney.edu.au %K veterans %K mental health %K technology %K community-based participatory research %K health care reform %K stakeholder participation %D 2019 %7 19.09.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The impact of mental ill-health on every aspect of the lives of a large number of Australian Defence Force (ADF) personnel, their partners, and their families is widely recognized. Recent Senate inquiries have highlighted gaps in service delivery as well as the need for service reform to ensure appropriate care options for individuals who are currently engaged with mental health and support services as well as for those who, for a variety of reasons, have not sought help. To that end, successive Australian governments generally and the Department of Veterans’ Affairs specifically have prioritized veteran-centric reform. Open Arms is an Australia-wide service that provides counseling and support to current and former ADF personnel, and their family members, for mental health conditions. Objective: The aim of this study was to develop and configure a prototypic Web-based platform for Open Arms – Veterans & Families Counselling (formerly Veterans and Veterans Families Counselling Service) with the Open Arms community to enhance the quality of mental health services provided by Open Arms. Methods: The study aimed to recruit up to 100 people from the Open Arms community (current and former ADF personnel and their families, health professionals, service managers, and administrators) in regions of New South Wales, including Sydney, Canberra, Maitland, Singleton, and Port Stephens. Participants were invited to participate in 4-hour participatory design workshops. A variety of methods were used within the workshops, including prompted discussion, review of working prototypes, creation of descriptive artifacts, and group-based development of user journeys. Results: Seven participatory design workshops were held, including a total of 49 participants. Participants highlighted that the prototype has the potential to (1) provide the opportunity for greater and better-informed personal choice in relation to options for care based on the level of need and personal preferences; (2) ensure transparency in care by providing the individual with access to all of their personal health information; and (3) improve collaborative care and care continuity by allowing information to be shared securely with current and future providers. Conclusions: Our findings highlight the value of actively engaging stakeholders in participatory design processes for the development and configuration of new technologies. %M 31538937 %R 10.2196/13662 %U http://formative.jmir.org/2019/3/e13662/ %U https://doi.org/10.2196/13662 %U http://www.ncbi.nlm.nih.gov/pubmed/31538937 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e14329 %T Psychiatry Outpatients’ Willingness to Share Social Media Posts and Smartphone Data for Research and Clinical Purposes: Survey Study %A Rieger,Agnes %A Gaines,Averi %A Barnett,Ian %A Baldassano,Claudia Frances %A Connolly Gibbons,Mary Beth %A Crits-Christoph,Paul %+ University of Pennsylvania, Suite 650, 3535 Market Street, Philadelphia, PA, 19104, United States, 1 215 662 7993, crits@pennmedicine.upenn.edu %K social media %K smartphone %K outpatients %K psychiatry %K psychotherapy %K digital health %K mhealth %K digital phenotyping %K privacy %K user preferences %D 2019 %7 29.8.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychiatry research has begun to leverage data collected from patients’ social media and smartphone use. However, information regarding the feasibility of utilizing such data in an outpatient setting and the acceptability of such data in research and practice is limited. Objective: This study aimed at understanding the outpatients’ willingness to have information from their social media posts and their smartphones used for clinical or research purposes. Methods: In this survey study, we surveyed patients (N=238) in an outpatient clinic waiting room. Willingness to share social media and passive smartphone data was summarized for the sample as a whole and broken down by sex, age, and race. Results: Most patients who had a social media account and who were receiving talk therapy treatment (74.4%, 99/133) indicated that they would be willing to share their social media posts with their therapists. The percentage of patients willing to share passive smartphone data with researchers varied from 40.8% (82/201) to 60.7% (122/201) depending on the parameter, with sleep duration being the parameter with the highest percentage of patients willing to share. A total of 30.4% of patients indicated that media stories of social media privacy breaches made them more hesitant about sharing passive smartphone data with researchers. Sex and race were associated with willingness to share smartphone data, with men and whites being the most willing to share. Conclusions: Our results indicate that most patients in a psychiatric outpatient setting would share social media and passive smartphone data and that further research elucidating patterns of willingness to share passive data is needed. %M 31493326 %R 10.2196/14329 %U http://formative.jmir.org/2019/3/e14329/ %U https://doi.org/10.2196/14329 %U http://www.ncbi.nlm.nih.gov/pubmed/31493326 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e14530 %T Using Computer Tablets to Improve Moods for Older Adults With Dementia and Interactions With Their Caregivers: Pilot Intervention Study %A Gilson,Aaron %A Dodds,Debby %A Kaur,Arveen %A Potteiger,Michael %A Ford II,James H %+ University of Wisconsin-Madison, School of Pharmacy, 777 Highland Ave, Madison, WI, 53705, United States, 1 608 262 4748, jhfordii@wisc.edu %K mood change %K caregiver interactions %K older adults %K Alzheimer disease %K dementia %K computer tablets %K person-centered care %D 2019 %7 03.09.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Persons living with dementia represent a significant and growing segment of the older adult (aged 65 years and older) population. They are often challenged expressively and may experience difficulties with sharing their feelings or moods. Availability of, and easy access to, tablets facilitates the use of information and communication technologies (ICTs) as a delivery mechanism for nonpharmacological interventions, especially for persons living with dementia. Evidence of the impact of ICTs in different community settings on mood with older adults and the impact of engagement on their caregivers is needed to promote broader adoption and sustainment of these technologies in the United States. Objective: This study aimed to determine the extent of the effects of tablets on positive mood change and examine the effects of study variables on care recipients’ mood changes and caregivers’ daily interactions. Methods: The tablet intervention was developed and evaluated in five programs. The primary outcome was caregivers’ assessment of care recipients’ mood (n=1089) before and after a tablet engagement session using an eight-point mood visual analog scale. Session influence on caregivers’ daily activities was captured for a subsample of participants (n=542). Frequency distributions were computed for each study variables. Chi-square tests of association were calculated to determine the association of the variables on mood changes for all care recipients, as well as those being treated in skilled nursing facilities and in-home, and then for those that affected caregivers’ daily activities. Results: The study sample comprised 1089 care recipient and caregiver engagement sessions. Cumulatively, 50.78% (553/1089) of care recipients showed a transition from negative to positive moods, whereas another 41.78% (455/1089) maintained an already-positive mood after the caregiver engagement session. Chi-square analyses demonstrated that positive mood changes resulted from using music (χ210=72.9; P<.001), using YouTube as the sole app (χ212=64.5; P<.001), using multiple engagement strategies (χ22=42.8; P<.001), and when cared for in a skilled nursing facility (χ24=236.8; P<.001) across the entire care recipient sample. In addition, although many features of the engagement session positively influenced the caregivers’ day, the largest effect was observed when care recipients’ mood was considered to have improved following the session (χ24=234.7; P<.001). Conclusions: The study is one of the first in the United States to explore the impact of ICTs, in particular managed tablets and Web-based video services that can be used on a tablet through an app, on improving mood in persons living with dementia, and enhancing caregivers’ perceptions about their care recipient interactions. Importantly, these pilot data substantiate ICTs as part of a personalized engagement approach, as beneficial alternatives to pharmaceutical interventions for mood enhancement. However, a more comprehensive study that explores the ICT’s impact on additional clinical outcomes is needed to confirm these preliminary findings. %M 31482847 %R 10.2196/14530 %U http://formative.jmir.org/2019/3/e14530/ %U https://doi.org/10.2196/14530 %U http://www.ncbi.nlm.nih.gov/pubmed/31482847 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e11555 %T Developing a Digital Solution for Dengue Through Epihack: Qualitative Evaluation Study of a Five-Day Health Hackathon in Sri Lanka %A Panchapakesan,Chitra %A Sheldenkar,Anita %A Wimalaratne,Prasad %A Wijayamuni,Ruwan %A Lwin,May Oo %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Singapore,, Singapore, 65 9446 6036, chitra002@e.ntu.edu.sg %K Epihack %K civic engagement %K dengue %K digital epidemiology %K participatory surveillance %K participatory epidemiology %K participatory design %K workshop %D 2019 %7 29.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Dengue is a mosquito-borne viral disease that has increasingly affected Sri Lanka in recent years. To address this issue, dengue surveillance through increasingly prevalent digital surveillance applications has been suggested for use by health authorities and the general public. Epihack Sri Lanka was a 5-day hackathon event organized to develop a digital dengue surveillance tool. Objective: The goal of the research was to examine the effectiveness of a collaborative hackathon that brought together information technology (IT) and health experts from around the globe to develop a solution to the dengue pandemic in Sri Lanka. Methods: Ethnographic observation and qualitative informal interviews were conducted with 58 attendees from 11 countries over the 5-day Epihack to identify the main factors that influence a collaborative hackathon. Interviews were transcribed and coded based on grounded theory. Results: Three major themes were identified during the Epihack Sri Lanka event: engagement, communication, and current disease environment. Unlike other hackathons, Epihack had no winners or prizes and was collaborative rather than competitive, which worked well in formulating a variety of ideas and bringing together volunteers with a sense of civic duty to improve public health. Having health and IT experts work together concurrently was received positively and considered highly beneficial to the development of the product. Participants were overall very satisfied with the event, although they thought it could have been longer. Communication issues and cultural differences were observed but continued to decrease as the event progressed. This was found to be extremely important to the efficiency of the event, which highlighted the benefit of team-bonding exercises. Bringing expert knowledge and examples of systems from around the world benefited the creation of new ideas. However, developing a system that can adapt and cater to the local disease environment is important in successfully developing the concepts. Conclusions: Epihack Sri Lanka was successful in bringing together health and IT experts to develop a digital solution for dengue surveillance. The collaborative format achieved a variety of fruitful ideas and may lead to more hackathons working in this way in the future. Good communication, participant engagement, and stakeholder interest with adaptation of ideas to complement the current environment are vital to achieve the goals of the event. %M 31469074 %R 10.2196/11555 %U http://formative.jmir.org/2019/3/e11555/ %U https://doi.org/10.2196/11555 %U http://www.ncbi.nlm.nih.gov/pubmed/31469074 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13411 %T Use of Smartphone-Based Video Directly Observed Therapy (vDOT) in Tuberculosis Care: Single-Arm, Prospective Feasibility Study %A Holzman,Samuel B %A Atre,Sachin %A Sahasrabudhe,Tushar %A Ambike,Sunil %A Jagtap,Deepak %A Sayyad,Yakub %A Kakrani,Arjun Lal %A Gupta,Amita %A Mave,Vidya %A Shah,Maunank %+ Division of Infectious Diseases, Johns Hopkins University School of Medicine, 1550 Orleans St, Cancer Research Building, Room 1M-10, Baltimore, MD,, United States, 1 443 287 0401, mshah28@jhmi.edu %K Video DOT %K mHealth %K tuberculosis %K medication adherence %K telemedicine %K India %K mobile phone %K smartphone %D 2019 %7 27.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: India accounts for nearly one-quarter of the global tuberculosis (TB) burden. Directly observed treatment (DOT) through in-person observation is recommended in India, although implementation has been heterogeneous due largely to resource limitations. Video DOT (vDOT) is a novel, smartphone-based approach that allows for remote treatment monitoring through patient-recorded videos. Prior studies in high-income, low disease burden settings, such as the United States, have shown vDOT to be feasible, although little is known about the role it may play in resource-limited, high-burden settings. Objective: The goal of the research was to assess the feasibility and acceptability of vDOT for adherence monitoring within a resource-limited, high TB burden setting of India. Methods: We conducted a prospective, single-arm, pilot implementation of vDOT in Pune, India. Outcome measures included adherence (proportion of prescribed doses observed by video) and verifiable fraction (proportion of prescribed doses observed by video or verbally confirmed with the patient following an incomplete/unverifiable video submission). vDOT acceptability among patients was assessed using a posttreatment survey. Results: A total of 25 patients enrolled. The median number of weeks on vDOT was 13 (interquartile range [IQR] 11-16). Median adherence was 74% (IQR 62%-84%), and median verifiable fraction was 86% (IQR 74%-98%). More than 90% of patients reported recording and uploading videos without difficulty. Conclusions: We have demonstrated that vDOT may be a feasible and acceptable approach to TB treatment monitoring in India. Our work expands the evidence base around vDOT by being one of the first efforts to evaluate vDOT within a resource-limited, high TB burden setting. To our knowledge, this is the first reported use of vDOT in India. %M 31456581 %R 10.2196/13411 %U http://formative.jmir.org/2019/3/e13411/ %U https://doi.org/10.2196/13411 %U http://www.ncbi.nlm.nih.gov/pubmed/31456581 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e12216 %T An Interactive Website for Whiplash Management (My Whiplash Navigator): Process Evaluation of Design and Implementation %A Bandong,Aila Nica %A Mackey,Martin %A Leaver,Andrew %A Ingram,Rodney %A Sterling,Michele %A Ritchie,Carrie %A Kelly,Joan %A Rebbeck,Trudy %+ Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, Sydney, 2141, Australia, 61 452578705, aban9213@uni.sydney.edu.au %K primary health care %K whiplash injuries %K clinical decision support %K clinical pathways %K rehabilitation %D 2019 %7 26.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Whiplash is a health and economic burden worldwide. Contributing to this burden is poor guideline adherence and variable management by health care professionals (HCPs). Web-based tools that facilitate clinical pathways of care are an innovative solution to improve management. Objective: The study aimed to develop, implement, and evaluate a Web-based tool to support whiplash management following a robust process. Methods: This study followed the first 3 processes of a research translation framework (idea generation, feasibility, and efficacy) to inform the development, implementation, and evaluation of a website that supports HCPs in whiplash management. Development followed the idea generation and feasibility processes to inform the content, design, features, and functionality of the website. This involved stakeholder (eg, industry partners, website developers, and HCPs) consultations through face-to-face meetings, surveys, and focus group discussions. Implementation followed the feasibility process to determine the practicality of the website for clinical use and the most effective strategy to promote wider uptake. Implementation strategies included classroom education, educational meetings, educational outreach, reminders, and direct phone contact. The analysis of website use and practicality of implementation involved collection of website metrics. Evaluation followed the feasibility and efficacy processes to investigate the acceptability and extent to which the website assisted HCPs in gaining knowledge about whiplash management. Surveys were conducted among student, primary, and specialist HCPs to explore ease of access, use, and satisfaction with the website, as well as self-rated improvements in knowledge of risk assessment, management, and communication between HCPs. Website logs of specialist management decisions (eg, shared care, specialist care, and referred care) were also obtained to determine actual practice. Results: The development process delivered an interactive, user-friendly, and acceptable website, My Whiplash Navigator, tailored to the needs of HCPs. A total of 260 registrations were recorded from June 2016 to March 2018, including 175 student, 65 primary, and 20 specialist HCPs. The most effective implementation strategies were classroom education for students (81% uptake, 175/215) and educational meetings for primary HCPs (43% uptake, 47/110). Popular pages visited included advice and exercises and risk assessment. Most HCPs agreed that their knowledge about risk management (79/97, 81%) and exercises (85/97, 88%) improved. The specialists’ most common management decision was shared care, an improvement from a previous cohort. Areas to improve were navigation and access to outcome measures. Conclusions: A robust process resulted in an innovative, interactive, user-friendly, and acceptable website, the My Whiplash Navigator. Implementation with HCPs was best achieved through classroom education and educational meetings. Evaluation of the website showed improved knowledge and practice to be more consistent with a risk-based clinical care pathway for whiplash. The positive results provide sufficient evidence to scale implementation nationally and involve other target markets such as people with whiplash, insurers, and insurance regulators. %M 31452515 %R 10.2196/12216 %U http://formative.jmir.org/2019/3/e12216/ %U https://doi.org/10.2196/12216 %U http://www.ncbi.nlm.nih.gov/pubmed/31452515 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e14788 %T An E-Learning Program for Increasing Physical Activity Associated Behaviors Among People with Spinal Cord Injury: Usability Study %A Wilroy,Jereme D %A Martin Ginis,Kathleen A %A Rimmer,James H %A Wen,Huacong %A Howell,Jennifer %A Lai,Byron %+ Department of Physical Medicine & Rehabilitation, University of Alabama at Birmingham, 1717 6th Avenue South, Birmingham, AL, 35233, United States, 1 205 934 9754, jdwilroy@uab.edu %K physical activity %K mhealth %K ehealth %K people with disabilities %K spinal cord injuries %D 2019 %7 21.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The majority of people with spinal cord injury (SCI) in the United States are not meeting the recommended guidelines for regular physical activity. Behavior change techniques (eg, goal setting and action planning) that are framed within the principles of the social cognitive theory (self-efficacy and self-regulation) have the potential to enhance physical activity behavior. Objective: The aim of the study was to develop and test the usability of an electronic learning (e-learning) program for improving social cognitive factors related to physical activity behavior among people with SCI. Methods: The program was created through an iterative process of development and refinement, using a modification of a similar methodology used to develop evidence-informed guidelines in health promotion for people with disabilities (Guidelines, Recommendations, and Adaptations Including Disability; GRAIDs framework). The study included 4 phases: (1) initial product creation, (2) national survey, (3) expert review, and (4) usability testing. Usability testing included both quantitative and qualitative data collection and analyses. Results: The review of the program by an expert panel (n=5) and the results from a national survey (n=142) led to several refinements. Usability testing demonstrated that the program could be completed in a timely manner (<30 min). Participants reported 5 themes: (1) the program improves social cognitions related to physical activity participation; (2) reflection of physical activity behavior; (3) positive perceptions of the quality of the program; (4) positive perceptions of the program operation and effectiveness; and (5) recommendations for improvement. Each item was incorporated into a revised program version 1.0. Conclusions: This study incorporated an evidence-based framework for developing a brief 30-min e-learning program for increasing the physical activity behavior among people with SCI. The Exercise Strategies Through Optimized Relevant Interactive E-learning Storytelling (e-STORIES) program could be completed in a timely manner and was reported by participants as valuable and useful for enhancing intent-to-perform physical activity in individuals with SCI. The program has the potential to be applied in a variety of settings, but feasibility testing is required before implementing in a larger trial. %M 31436161 %R 10.2196/14788 %U http://formative.jmir.org/2019/3/e14788/ %U https://doi.org/10.2196/14788 %U http://www.ncbi.nlm.nih.gov/pubmed/31436161 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e12972 %T The Importance of Systematically Reporting and Reflecting on eHealth Development: Participatory Development Process of a Virtual Reality Application for Forensic Mental Health Care %A Kip,Hanneke %A Kelders,Saskia M %A Bouman,Yvonne H A %A van Gemert-Pijnen,Lisette J E W C %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 534896536, h.kip@utwente.nl %K eHealth %K technology development %K virtual reality %K forensic psychiatry %K community-based participatory research %K human-centered design %K case study %D 2019 %7 19.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of electronic health (eHealth) technologies in practice often is lower than expected, mostly because there is no optimal fit among a technology, the characteristics of prospective users, and their context. To improve this fit, a thorough systematic development process is recommended. However, more knowledge about suitable development methods is necessary to create a tool kit that guides researchers in choosing development methods that are appropriate for their context and users. In addition, there is a need for reflection on the existing frameworks for eHealth development to be able to constantly improve them. Objective: The two main objectives of this case study were to present and reflect on the (1) methods used in the development process of a virtual reality application for forensic mental health care and (2) development model that was used: the CeHRes Roadmap (the Centre for eHealth Research Roadmap). Methods: In the development process, multiple methods were used to operationalize the first 2 phases of the CeHRes Roadmap: the contextual inquiry and value specification. To summarize the most relevant information for the goals of this study, the following information was extracted per method: (1) research goal, (2) explanation of the method used, (3) main results, (4) main conclusions, and (5) lessons learned about the method. Results: Information on 10 methods used is presented in a structured manner. These 10 methods were stakeholder identification, project team composition, focus groups, literature study, semistructured interviews, idea generation with scenarios, Web-based questionnaire, value specification, idea generation with prototyping, and a second round of interviews. The lessons learned showed that although each method added new insights to the development process, not every method appeared to be the most appropriate for each research goal. Conclusions: Reflection on the methods used pointed out that brief methods with concrete examples or scenarios fit the forensic psychiatric patients the best, among other things, because of difficulties with abstract reasoning and low motivation to invest much time in participating in research. Formulating clear research questions based on a model’s underlying principles and composing a multidisciplinary project team with prospective end users appeared to be important in this study. The research questions supported the project team in keeping the complex development processes structured and prevented tunnel vision. With regard to the CeHRes Roadmap, continuous stakeholder involvement and formative evaluations were evaluated as strong points. A suggestion to further improve the Roadmap is to explicitly integrate the use of domain-specific theories and models. To create a tool kit with a broad range of methods for eHealth development and further improve development models, studies that report and reflect on development processes in a consistent and structured manner are needed. %M 31429415 %R 10.2196/12972 %U http://www.jmir.org/2019/8/e12972/ %U https://doi.org/10.2196/12972 %U http://www.ncbi.nlm.nih.gov/pubmed/31429415 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e14438 %T Validity of the Polar M430 Activity Monitor in Free-Living Conditions: Validation Study %A Henriksen,André %A Grimsgaard,Sameline %A Horsch,Alexander %A Hartvigsen,Gunnar %A Hopstock,Laila %+ Department of Community Medicine, UiT The Arctic University of Norway, Postboks 6050 Langnes, Tromsø, 9037, Norway, 47 77645214, andre.henriksen@uit.no %K actigraphy %K fitness trackers %K motor activity %K validation studies %D 2019 %7 16.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Accelerometers, often in conjunction with heart rate sensors, are extensively used to track physical activity (PA) in research. Research-grade instruments are often expensive and have limited battery capacity, limited storage, and high participant burden. Consumer-based activity trackers are equipped with similar technology and designed for long-term wear, and can therefore potentially be used in research. Objective: We aimed to assess the criterion validity of the Polar M430 sport watch, compared with 2 research-grade instruments (ActiGraph and Actiheart), worn on 4 different locations using 1- and 3-axis accelerometers. Methods: A total of 50 participants wore 2 ActiGraphs (wrist and hip), 2 Actihearts (upper and lower chest position), and 1 Polar M430 sport watch for 1 full day. We compared reported time (minutes) spent in sedentary behavior and in light, moderate, vigorous, and moderate to vigorous PA, step counts, activity energy expenditure, and total energy expenditure between devices. We used Pearson correlations, intraclass correlations, mean absolute percentage errors (MAPEs), and Bland-Altman plots to assess criterion validity. Results: Pearson correlations between the Polar M430 and all research-grade instruments were moderate or stronger for vigorous PA (r range .59-.76), moderate to vigorous PA (r range .51-.75), steps (r range .85-.87), total energy expenditure (r range .88-.94), and activity energy expenditure (r range .74-.79). Bland-Altman plots showed higher agreement for higher intensities of PA. MAPE was high for most outcomes. Only total energy expenditure measured by the hip-worn ActiGraph and both Actiheart positions had acceptable or close to acceptable errors with MAPEs of 6.94% (ActiGraph, 3 axes), 8.26% (ActiGraph, 1 axis), 14.54% (Actiheart, upper position), and 14.37% (Actiheart, lower position). The wrist-worn ActiGraph had a MAPE of 15.94% for measuring steps. All other outcomes had a MAPE of 22% or higher. For most outcomes, the Polar M430 was most strongly correlated with the hip-worn triaxial ActiGraph, with a moderate or strong Pearson correlation for sedentary behavior (r=.52) and for light (r=.7), moderate (r=.57), vigorous (r=.76), and moderate to vigorous (r=.75) PA. In addition, correlations were strong or very strong for activity energy expenditure (r=.75), steps (r=.85), and total energy expenditure (r=.91). Conclusions: The Polar M430 can potentially be used as an addition to established research-grade instruments to collect some PA variables over a prolonged period. However, due to the high MAPE of most outcomes, only total energy expenditure can be trusted to provide close to valid results. Depending on the variable, the Polar M430 over- or underreported most metrics, and may therefore be better suited to report changes in PA over time for some outcomes, rather than as an accurate instrument for PA status in a population. %M 31420958 %R 10.2196/14438 %U http://formative.jmir.org/2019/3/e14438/ %U https://doi.org/10.2196/14438 %U http://www.ncbi.nlm.nih.gov/pubmed/31420958 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13643 %T Pedal-Assist Mountain Bikes: A Pilot Study Comparison of the Exercise Response, Perceptions, and Beliefs of Experienced Mountain Bikers %A Hall,Cougar %A Hoj,Taylor H %A Julian,Clark %A Wright,Geoff %A Chaney,Robert A %A Crookston,Benjamin %A West,Joshua %+ Department of Public Health, Brigham Young University, 2140 Life Science Building, Provo, UT, 84602, United States, 1 8014225656, cougar_hall@byu.edu %K public health %K physical activity %K heart rate %D 2019 %7 13.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Mountain biking is an aerobic physical activity that has experienced rapid growth. The emergence of the electric pedal-assist mountain bike (eMTB), while not without its critics, presents the potential for an even larger segment of the population to enjoy the health benefits of mountain biking. Although the research focused on the use of e-bikes generally is growing, there is limited research specifically targeting eMTB use. Research is needed exploring the potential exercise response of riding an eMTB, together with the beliefs and perceptions of mountain bikers who have and have not experienced eMTB riding. Objective: This study aimed to compare conventional mountain bike and eMTB use. This was done by investigating 2 questions: (1) What proportion of exercise response is retained for an experienced mountain biker while using an eMTB when compared with a conventional mountain bike? and (2) What are the perceptions and beliefs of experienced mountain bikers toward eMTBs both before and after riding an eMTB? Methods: A convergent mixed methods data collection approach was used in the study. Participants completed both a pre- and postride questionnaire, and data regarding heart rate were collected. Heart rates from each ride were compared against each other. Results: The average heart rate during eMTB use was 94% (31/33) of the average heart rate during conventional mountain bike use. Therefore, eMTB use in this study achieved a majority of the exercise response and exceeded established biometric thresholds for cardiovascular fitness. Paired t test statistics were calculated to compare beliefs of conventional mountain bikes and eMTBs and to compare mean heart rate and speed between conventional mountain bike and eMTB use on the study loop. Participants overwhelmingly perceived the potential impact of eMTB use to be positive on both pre- and post-eMTB ride questionnaires. Conclusions: Despite the measured benefit, participants’ perceived exertion while riding the eMTB was low. %M 31411139 %R 10.2196/13643 %U http://formative.jmir.org/2019/3/e13643/ %U https://doi.org/10.2196/13643 %U http://www.ncbi.nlm.nih.gov/pubmed/31411139 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e12824 %T A Health Education Website Developed to Meet Young People’s Information Needs About Web-Based Pornography and Sharing of Sexually Explicit Imagery (SCOPE): Usability Study %A Davis,Angela C %A Wright,Cassandra J C %A Temple-Smith,Meredith J %A Hellard,Margaret E %A Lim,Megan S C %+ Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia, 61 385062403, megan.lim@burnet.edu.au %K adolescent %K pornography %K health promotion %K internet %K sex education %D 2019 %7 13.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Although we know that many young people watch online pornography and engage in sexting, there is limited literature examining their needs in relation to information on these highly sensitive and complex issues. Online resources exist; however, we can find no evidence of any of them having been formally tested for usability within the target population. Objective: This study aimed to test the usability of a resource about online pornography and sexting among young people. Methods: Semistructured interviews were conducted with 17 participants aged 15 to 29 years. Results: We found that the SCOPE resource was perceived as trustworthy and credible because of its evidence-based content, nonjudgmental tone, and balanced perspectives. Multimedia and video content enhanced the layout and usability of the resource; however, content relevance could be improved by targeting age and developmental stages. Participants identified resource sections such as Real Stories from young people as relevant and engaging. However, they raised issues with the translation of formative research findings relating to these stories into their final presentation. Conclusions: Our findings suggest that young people prefer online resources about complex issues, such as online pornography and sexting, if they are balanced in content and tone. Most importantly, in the context of responding to complex and sensitive issues such as these, co-design methods can ensure that young people are central to the development of resources and avoid gaps in translating research into practice. In the context of limited literature focusing on the usability of online resources about these topics, this paper provides important insights for public health practitioners working in this emerging space. %M 31411140 %R 10.2196/12824 %U http://formative.jmir.org/2019/3/e12824/ %U https://doi.org/10.2196/12824 %U http://www.ncbi.nlm.nih.gov/pubmed/31411140 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e12675 %T Use of Short Messaging Service to Improve Follow-Up for Abnormal Pap Test Results in Minority and Medically Underserved Women in North Carolina: Questionnaire on Attitudes and Acceptability %A Romocki,LaHoma Smith %A Des Marais,Andrea %A Cofie,Leslie %A Anderson,Chelsea %A Curington,Theresa %A Smith,Jennifer Susan %+ Department of Public Health Education, North Carolina Central University, 1801 Fayetteville Street, Durham, NC, 27707, United States, 1 919 530 6404, lromocki@nccu.edu %K cervical cancer %K Pap tests %K abnormal results %K text messaging %K appointment reminders %D 2019 %7 06.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: An estimated one in eight cervical cancer cases are due to a lack of follow-up care for abnormal Pap test results. Low rates of completion of follow-up care particularly affect low-income minority women. The burden of cervical cancer could be reduced through interventions that improve timely colposcopy follow-up and treatment of abnormal screening results. Mobile communications via text messaging present a low-cost opportunity to increase rates of clinic return among women referred to follow-up after obtaining abnormal screening results. Objective: Our aims were to determine the acceptability and feasibility of using text messaging to increase completion of follow-up care following abnormal cervical cancer screening (Pap test) results and to examine factors that may affect the acceptability and use of text messaging to increase communications between health care providers (HCP) and low-income minority women. Methods: The study participants were 15 low-income women who had undergone a Pap test within the preceding 12 months. Semistructured interviews, including open- and closed-ended questions from a validated questionnaire, were conducted by phone or in person. Responses to closed-ended survey items were tabulated, and descriptive statistics were generated using Microsoft Excel. Responses to the open-ended questions were coded and analyzed using NVivo 11 qualitative analysis software. Results: Nearly all participants (14/15, 93%) were comfortable receiving a text message from an HCP stating that their Pap test results were available (<40 years: 100%; ≥40 years: 86%). Over half (8/15; 53%) of the participants were comfortable receiving a text message stating that their Pap test results were abnormal, although many preferred to receive such information via a phone call (6/15; 40%). Most participants (9/15; 60%) believed that receiving a text reminder would make them more likely to attend their appointment. The preferred method for receiving a reminder appeared to vary by age, with older women preferring telephone reminders over text messaging reminders. Analysis of open-ended questions suggested that text messaging appeals to some women due to its wide use and convenience for communicating with HCPs. However, women cited concerns about the confidentiality of messages and barriers to understanding the messages, including the physical capacity to read and accurately interpret the content of the messaging. Conclusions: Most participants indicated a willingness to receive text messages from their HCPs about cervical cancer screening results and believed that text messages were the best way to remind them of appointments for follow-up care. Potential concerns could be addressed by excluding explicit references to the nature of the appointment in the text message in order to avoid disclosure of sensitive health information to unauthorized individuals. Although text messaging seems promising to improve adherence to timely follow-up, personal preferences should be considered by allowing patients to opt-out of text communications. %M 31389334 %R 10.2196/12675 %U https://formative.jmir.org/2019/3/e12675/ %U https://doi.org/10.2196/12675 %U http://www.ncbi.nlm.nih.gov/pubmed/31389334 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13621 %T Redesigning a Sentinel Surveillance System for Collecting and Disseminating Near Real-Time Agricultural Injury Reports: System Usability Study %A Weichelt,Bryan %A Heimonen,Tomi %A Gorucu,Serap %A Redmond,Emily %A Vechinski,Josef %A Pflughoeft,Kurt %A Bendixsen,Casper %A Salzwedel,Marsha %A Scott,Erika %A Namkoong,Kang %A Purschwitz,Mark %A Rautiainen,Risto %A Murphy,Dennis J %+ National Farm Medicine Center, Marshfield Clinic Research Institute, 1000 N Oak Ave, Marshfield, WI, 54449, United States, 1 7152217276, weichelt.bryan@marshfieldresearch.org %K agriculture %K risk %K wounds and injuries %K safety %K farms %K news %K newspaper article %D 2019 %7 02.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Injury data and reports provide valuable information for both public and private organizations to guide programming, policy, and prevention, but in the increasingly complex and dangerous industry of US agriculture, the injury surveillance needed to produce this data is lacking. To address the gap, AgInjuryNews was established in 2015. The system includes fatal and nonfatal injury cases derived from publicly available reports, including occupational and nonoccupational injuries, occurring in the agricultural, forestry, and fishing (AFF) industry. Objective: The study aimed to develop a stakeholder-engaged redesign of the interactive, up-to-date, and publicly available dataset of US AFF injury and fatality reports. Methods: Instructor-led heuristic evaluations within a 15-student undergraduate course, data from 8 student participants of laboratory-based usability testing and 2016 and 2017 AgInjuryNews-registered user surveys, coupled with input from the National Steering Committee informed the development priorities for 2018. An interdisciplinary team employed an agile methodology of 2-week sprints developing in ASP.NET and Structured Query Language to deliver an intuitive frontend and a flexible, yet structured, backend, including a case report input form for capturing more than 50 data points on each injury report. Results: AgInjuryNews produced 17,714 page views from 43 countries in 2018 captured via Google Analytics, whereas 623 injury reports were coded and loaded, totaling more than 31,000 data points. Newly designed features include customizable email alerts, an interactive map, and expanded search and filter options. User groups such as the Bureau of Labor Statistics and the Agricultural Safety and Health Council of America have endorsed the system within their networks. News media have cited or referenced the system in national outlets such as the New York Times, Politico, and the Washington Post. Conclusions: The new system’s features, functions, and improved data granularity have sparked innovative lines of research and increased collaborative interest domestically and abroad. It is anticipated that this nontraditional sentinel surveillance system and its dataset will continue to serve many purposes for public and private agricultural safety and health stakeholders in the years to come.  %M 31376278 %R 10.2196/13621 %U http://formative.jmir.org/2019/3/e13621/ %U https://doi.org/10.2196/13621 %U http://www.ncbi.nlm.nih.gov/pubmed/31376278 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13898 %T The Internet-Based Cognitive Assessment Tool: System Design and Feasibility Study %A Hafiz,Pegah %A Miskowiak,Kamilla Woznica %A Kessing,Lars Vedel %A Elleby Jespersen,Andreas %A Obenhausen,Kia %A Gulyas,Lorant %A Zukowska,Katarzyna %A Bardram,Jakob Eyvind %+ Digital Health Section, Department of Health Technology, Technical University of Denmark, Richard Petersens Plads, Building 324, 2nd Floor, Room 270, Kongens Lyngby, 2800, Denmark, 45 91858371, pegh@dtu.dk %K screening %K memory %K executive function %K bipolar disorder %K depression %K cognitive impairments %K neuropsychological tests %K computer software %K speech recognition software %D 2019 %7 26.07.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Persistent cognitive impairment is prevalent in unipolar and bipolar disorders and is associated with decreased quality of life and psychosocial dysfunction. The screen for cognitive impairment in psychiatry (SCIP) test is a validated paper-and-pencil instrument for the assessment of cognition in affective disorders. However, there is no digital cognitive screening tool for the brief and accurate assessment of cognitive impairments in this patient group. Objective: In this paper, we present the design process and feasibility study of the internet-based cognitive assessment tool (ICAT) that is designed based on the cognitive tasks of the SCIP. The aims of this feasibility study were to perform the following tasks among healthy individuals: (1) evaluate the usability of the ICAT, (2) investigate the feasibility of the ICAT as a patient-administered cognitive assessment tool, and (3) examine the performance of automatic speech recognition (ASR) for the assessment of verbal recall. Methods: The ICAT was developed in a user-centered design process. The cognitive measures of the ICAT were immediate and delayed recall, working memory, and psychomotor speed. Usability and feasibility studies were conducted separately with 2 groups of healthy individuals (N=21 and N=19, respectively). ICAT tests were available in the English and Danish languages. The participants were asked to fill in the post study system usability questionnaire (PSSUQ) upon completing the ICAT test. Verbal recall in the ICAT was assessed using ASR, and the performance evaluation criterion was word error rate (WER). A Pearson 2-tailed correlation analysis significant at the .05 level was applied to investigate the association between the SCIP and ICAT scores. Results: The overall psychometric factors of PSSUQ for both studies gave scores above 4 (out of 5). The analysis of the feasibility study revealed a moderate to strong correlation between the total scores of the SCIP and ICAT (r=0.63; P=.009). There were also moderate to strong correlations between the SCIP and ICAT subtests for immediate verbal recall (r=0.67; P=.002) and psychomotor speed (r=0.71; P=.001). The associations between the respective subtests for working memory, executive function, and delayed recall, however, were not statistically significant. The corresponding WER for English and Danish responses were 17.8% and 6.3%, respectively. Conclusions: The ICAT is the first digital screening instrument modified from the SCIP using Web-based technology and ASR. There was good accuracy of the ASR for verbal memory assessment. The moderate correlation between the ICAT and SCIP scores suggests that the ICAT is a valid tool for assessing cognition, although this should be confirmed in a larger study with greater statistical power. Taken together, the ICAT seems to be a valid Web-based cognitive assessment tool that, after some minor modifications and further validation, may be used to screen for cognitive impairment in clinical settings. %M 31350840 %R 10.2196/13898 %U http://formative.jmir.org/2019/3/e13898/ %U https://doi.org/10.2196/13898 %U http://www.ncbi.nlm.nih.gov/pubmed/31350840 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e12507 %T A Web-Based Physical Activity Portal for Individuals Living With a Spinal Cord Injury: Qualitative Study %A Pancer,Max %A Manganaro,Melissa %A Pace,Isabella %A Marion,Patrick %A Gagnon,Dany H %A Laramée,Marie-Thérèse %A Messier,Frédéric %A Amari,Fatima %A Ahmed,Sara %+ School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada, 1 514 487 1891 ext 185, sara.ahmed@mcgill.ca %K spinal cord injuries %K self-management %K internet %K exercise %K motivation %K volition %D 2019 %7 26.07.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The population with a spinal cord injury (SCI) largely remains inactive following discharge from rehabilitation despite evidence on the benefits of physical activity. These individuals need to develop skills to self-manage their condition in order to prevent secondary comorbidities and rehospitalization. A Web-based physical activity portal can address this need. Few Web-based interventions incorporate theoretical frameworks, behavior change techniques, and modes of delivery into their design. Objective: This study aimed to identify the preferred features of a Web-based self-management physical activity portal through stakeholder engagement with individuals with a spinal cord injury and health care professionals (HCPs). Methods: An interpretative phenomenology methodology and participatory design, along with an integrated knowledge translation approach, were used to conduct this study. Convenience sampling was used to recruit individuals with an SCI living in the community, who were either interested or already engaging in physical activity, and HCPs working with individuals with an SCI, from three city-based rehabilitation sites. Individual 1-hour sessions involving navigation of an existing website and a semistructured interview were conducted with all participants. Individuals with an SCI completed a demographics questionnaire prior to the individual sessions, while demographic information of the HCPs was collected during their interviews. Additionally, all participants were asked a question on their intention to use or recommend a portal. An in-depth thematic analysis was used to derive themes from participants’ responses. Results: Thirteen individuals with an SCI and nine HCPs participated in the study. Five core themes emerged: (1) knowledge: guidance and barrier management; (2) possibility of achievement: the risks and benefits of physical activity and modelling; (3) self-regulation strategies: action planning, goal setting, tracking, rewards, and reminders; (4) interactivity: peers and professionals; and (5) format: appearance, language, and ease of use. The mean (median) ratings of the likelihood of promoting and using a Web-based portal tailored to individuals’ needs were 9.00 (8.78) and 7.75 (7.88) for HCPs and individuals with an SCI, respectively. Conclusions: This study highlights features of an online self-management platform that can provide individuals with an SCI the motivation and volition to engage in physical activity. These findings will inform the design of a Web-based self-management physical activity portal to increase physical activity adherence and behavior change. %M 31350835 %R 10.2196/12507 %U http://formative.jmir.org/2019/3/e12507/ %U https://doi.org/10.2196/12507 %U http://www.ncbi.nlm.nih.gov/pubmed/31350835 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e12389 %T Web-Based Prescription Opioid Abuse Prevention for Adolescents: Program Development and Formative Evaluation %A Moore,Sarah K %A Grabinski,Michael %A Bessen,Sarah %A Borodovsky,Jacob T %A Marsch,Lisa A %+ Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, 46 Centerra Parkway, EverGreen Suite 315, Lebanon, NH, 03766, United States, 1 9176789280, sarah.k.moore@dartmouth.edu %K opioids %K prevention and control %K adolescent %K randomized controlled trial %K internet %D 2019 %7 19.07.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The unprecedented number of youths engaged in nonmedical use of prescription opioids (POs), as well as the myriad negative consequences of such misuse, emphasizes the importance of prevention efforts targeting this public health crisis. Although there are several science-based, interactive drug abuse prevention programs focused on preventing the use of nonprescription drugs in youths, to our knowledge, there are no science-based interactive programs that focus on the prevention of PO abuse among adolescents. Objective: The aim of this study was to develop and conduct a formative evaluation of a science-based interactive Web-based program focused on the prevention of PO abuse among adolescents aged 12 to 17 years (Pop4Teens). This study was conducted to prepare for a randomized controlled trial designed to evaluate the effectiveness of Pop4Teens compared with an active control website, JustThinkTwice.com (Drug Enforcement Administration), in impacting knowledge and attitudes about POs and perceptions of risk associated with the abuse of POs, as well as intentions to use and actual use of POs. Methods: We conducted 6 focus groups with 30 youths (a mean of 5 per group: the eligibility being aged 12-19 years) along a continuum of exposure to POs (in treatment for opioid use disorder, in general treatment for other substance use disorder, prescribed an opioid, and opioid-naïve) and writing sessions with 30 youths in treatment for opioid use disorder (12-19 years) to inform the development of the Web-based prevention tool. Feasibility and acceptability of a prototype of the Web-based intervention were then assessed through individual feedback sessions with 57 youths (drawn from the same populations as the focus groups). Results: We successfully completed the development of a Web-based PO abuse prevention program (Pop4Teens). Analyses of focus group transcripts informed the development of the program (eg, quiz content/format, script writing, and story editing). Selected writing session narratives anchored the planned scientific content by lending credibility and informing the development of compelling storylines intended to motivate the youth to engage with the program. Feedback session data indicated that the Web-based tool could be potentially useful and acceptable. In addition, feedback session participants demonstrated significant increases in their knowledge of key topics related to the prevention of PO abuse after the exposure to sections of the Web-based program. Conclusions: The opioid crisis is predicted to get worse before it gets better. An effective response will likely require a multipronged strategy inclusive of effective evidence-based prevention programs acceptable to, and accessible by, a majority of youths. %M 31325289 %R 10.2196/12389 %U http://formative.jmir.org/2019/3/e12389/ %U https://doi.org/10.2196/12389 %U http://www.ncbi.nlm.nih.gov/pubmed/31325289 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13798 %T Audience Response Systems and Missingness Trends: Using Interactive Polling Systems to Gather Sensitive Health Information From Youth %A Toscos,Tammy %A Drouin,Michelle %A Flanagan,Mindy %A Carpenter,Maria %A Kerrigan,Connie %A Carpenter,Colleen %A Mere,Cameron %A Haaff,Marcia %+ Parkview Research Center, 10622 Parkview Plaza Dr, Fort Wayne, IN, 46845, United States, 1 260 266 5586, Tammy.Toscos@parkview.com %K mental health %K youth %K surveys and questionnaires %K health care %K software %D 2019 %7 16.07.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The widespread availability and cost-effectiveness of new-wave software-based audience response systems (ARSs) have expanded the possibilities of collecting health data from hard-to-reach populations, including youth. However, with all survey methods, biases in the data may exist because of participant nonresponse. Objective: The aims of this study were to (1) examine the extent to which an ARS could be used to gather health information from youths within a large-group school setting and (2) examine individual- and survey-level response biases stemming from this Web-based data collection method. Methods: We used an ARS to deliver a mental health survey to 3418 youths in 4 high schools in the Midwestern United States. The survey contained demographic questions, depression, anxiety, and suicidality screeners, and questions about their use of offline resources (eg, parents, peers, and counselors) and Web-based resources (ie, telemental health technologies) when they faced stressful life situations. We then examined the response rates for each survey item, focusing on the individual- and survey-level characteristics that related to nonresponse. Results: Overall, 25.39% (868/3418) of youths answered all 38 survey questions; however, missingness analyses showed that there were some survey structure factors that led to higher rates of nonresponse (eg, questions at the end of survey, sensitive questions, and questions for which precise answers were difficult to provide). There were also some personal characteristics that were associated with nonresponse (eg, not identifying as either male or female, nonwhite ethnicity, and higher levels of depression). Specifically, a multivariate model showed that male students and students who reported their gender as other had significantly higher numbers of missed items compared with female students (B=.30 and B=.47, respectively, P<.001). Similarly, nonwhite race (B=.39, P<.001) and higher depression scores (B=.39, P<.001) were positively related to the number of missing survey responses. Conclusions: Although our methodology-focused study showed that it is possible to gather sensitive mental health data from youths in large groups using ARSs, we also suggest that these nonresponse patterns need to be considered and controlled for when using ARSs for gathering population health data. %M 31313658 %R 10.2196/13798 %U https://formative.jmir.org/2019/3/e13798/ %U https://doi.org/10.2196/13798 %U http://www.ncbi.nlm.nih.gov/pubmed/31313658 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13417 %T Development and Usability of ADappt: Web-Based Tool to Support Clinicians, Patients, and Caregivers in the Diagnosis of Mild Cognitive Impairment and Alzheimer Disease %A van Maurik,Ingrid S %A Visser,Leonie NC %A Pel-Littel,Ruth E %A van Buchem,Marieke M %A Zwan,Marissa D %A Kunneman,Marleen %A Pelkmans,Wiesje %A Bouwman,Femke H %A Minkman,Mirella %A Schoonenboom,Niki %A Scheltens,Philip %A Smets,Ellen MA %A van der Flier,Wiesje M %+ Alzheimer Center Amsterdam, Department of Neurology, Amsterdam Neuroscience, Vrije Universiteit Amsterdam, Amsterdam UMC, De Boelelaan 1118, Amsterdam, 1081 HZ, Netherlands, 31 204440816, i.vanmaurik@vumc.nl %K Alzheimer’s disease %K biomarkers %K decision aids %K mild cognitive impairment %K precision medicine %K risk %K shared decision making %D 2019 %7 08.07.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: As a result of advances in diagnostic testing in the field of Alzheimer disease (AD), patients are diagnosed in earlier stages of the disease, for example, in the stage of mild cognitive impairment (MCI). This poses novel challenges for a clinician during the diagnostic workup with regard to diagnostic testing itself, namely, which tests are to be performed, but also on how to engage patients in this decision and how to communicate test results. As a result, tools to support decision making and improve risk communication could be valuable for clinicians and patients. Objective: The aim of this study was to present the design, development, and testing of a Web-based tool for clinicians in a memory clinic setting and to ascertain whether this tool can (1) facilitate the interpretation of biomarker results in individual patients with MCI regarding their risk of progression to dementia, (2) support clinicians in communicating biomarker test results and risks to MCI patients and their caregivers, and (3) support clinicians in a process of shared decision making regarding the diagnostic workup of AD. Methods: A multiphase mixed-methods approach was used. Phase 1 consisted of a qualitative needs assessment among professionals, patients, and caregivers; phase 2, consisted of an iterative process of development and the design of the tool (ADappt); and phase 3 consisted of a quantitative and qualitative assessment of usability and acceptability of ADappt. Across these phases, co-creation was realized via a user-centered qualitative approach with clinicians, patients, and caregivers. Results: In phase 1, clinicians indicated the need for risk calculation tools and visual aids to communicate test results to patients. Patients and caregivers expressed their needs for more specific information on their risk for developing AD and related consequences. In phase 2, we developed the content and graphical design of ADappt encompassing 3 modules: a risk calculation tool, a risk communication tool including a summary sheet for patients and caregivers, and a conversation starter to support shared decision making regarding the diagnostic workup. In phase 3, ADappt was considered to be clear and user-friendly. Conclusions: Clinicians in a memory clinic setting can use ADappt, a Web-based tool, developed using multiphase design and co-creation, for support that includes an individually tailored interpretation of biomarker test results, communication of test results and risks to patients and their caregivers, and shared decision making on diagnostic testing. %M 31287061 %R 10.2196/13417 %U https://formative.jmir.org/2019/3/e13417/ %U https://doi.org/10.2196/13417 %U http://www.ncbi.nlm.nih.gov/pubmed/31287061 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12657 %T Feasibility of Using Short Message Service and In-Depth Interviews to Collect Data on Contraceptive Use Among Young, Unmarried, Sexually Active Men in Moshi, Tanzania, and Addis Ababa, Ethiopia: Mixed Methods Study With a Longitudinal Follow-Up %A Pima,Francis Maganga %A Oshosen,Martha %A Ngowi,Kennedy Michael %A Habte,Bruck Messele %A Maro,Eusebious %A Teffera,Belete Eshete %A Kisigo,Godfrey %A Swai,Iraseni Ufoo %A Msangi,Salim Semvua %A Ermias,Amha %A Mmbaga,Blandina T %A Both,Rosalijn %A Sumari-de Boer,Marion %+ Department of Clinical Trials, Kilimanjaro Clinical Research Institute, PO Box 2236, Moshi,, United Republic of Tanzania, 255 754331948, m.sumari@kcri.ac.tz %K SMS %K contraceptives %K sexual behavior %K feasibility %K young unmarried men %D 2019 %7 26.06.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Data on contraceptive needs and use among young unmarried men are limited. Conventional ways of data collection may lead to limited and unreliable information on contraceptive use due to sensitivity of the topic, as many young men feel ashamed to discuss their behavior of using contraceptives. As short message service (SMS) is anonymous and a commonly used means of communication, we believe that if deployed, it will create a promising user-friendly method of data collection. Objective: The objective was to investigate the feasibility of using SMS to collect data on sexually active, young, unmarried men’s sexual behavior and contraceptive preferences, practices, and needs in Addis Ababa, Ethiopia, and Moshi, Tanzania. Methods: We enrolled men aged 18-30 years who were students (in Ethiopia and Tanzania), taxi or local bus drivers/assistants (Ethiopia and Tanzania), Kilimanjaro porters (Tanzania), or construction workers (Ethiopia). Young men were interviewed using a topic list on contraceptive use. They were followed up for 6 months by sending fortnightly SMS texts with questions about contraceptive use. If the young men indicated that they needed contraceptives during the reporting period or were not satisfied with the method they used, they were invited for a follow-up interview. At the end of the study, we conducted exit interviews telephonically using a semistructured questionnaire to explore the feasibility, acceptability, and accuracy of using SMS to validate the study findings in both countries. Results: We enrolled 71 young unmarried men—35 in Tanzania and 36 in Ethiopia. In Moshi, 1908 messages were delivered to participants and 1119 SMS responses were obtained. In Ethiopia, however, only 525 messages were sent to participants and 248 replies were received. The question on dating a girl in the past weeks was asked 438 times in Tanzania and received 252 (58%) replies, of which 148 (59%) were “YES.” In Ethiopia, this question was asked 314 times and received 64 (20%) replies, of which 52 (81%) were “YES” (P=.02 for difference in replies between Tanzania and Ethiopia). In Tanzania, the question on contraceptive use was sent successfully 112 times and received 108 (96%) replies, of which 105 (94%) were “YES.” In Ethiopia, the question on contraceptive use was asked 17 times and received only 2 (11%) replies. Exit interviews in Tanzania showed that SMS was accepted as a means of data collection by 22 (88%) of the 25 interviewed participants. Conclusions: Despite network and individual challenges, the SMS system was found to be feasible in Moshi, but not in Addis Ababa. We recommend more research to scale up the method in different groups and regions. %M 31244476 %R 10.2196/12657 %U http://formative.jmir.org/2019/2/e12657/ %U https://doi.org/10.2196/12657 %U http://www.ncbi.nlm.nih.gov/pubmed/31244476 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13558 %T The Feasibility of a Using a Smart Button Mobile Health System to Self-Track Medication Adherence and Deliver Tailored Short Message Service Text Message Feedback %A Bartlett Ellis,Rebecca J %A Hill,James H %A Kerley,K Denise %A Sinha,Arjun %A Ganci,Aaron %A Russell,Cynthia L %+ Science of Nursing Care Department, Indiana University School of Nursing, 600 Barnhill Drive, E423, Indianapolis, IN, 46202, United States, 1 (317) 274 0047, rjbartle@iu.edu %K medication adherence %K medication compliance %K behavior change %D 2019 %7 25.06.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: As many as 50% of people experience medication nonadherence, yet studies for detecting nonadherence and delivering real-time interventions to improve adherence are lacking. Mobile health (mHealth) technologies show promise to track and support medication adherence. Objective: The study aimed to evaluate the feasibility and acceptability of using an mHealth system for medication adherence tracking and intervention delivery. The mHealth system comprises a smart button device to self-track medication taking, a companion smartphone app, a computer algorithm used to determine adherence and then deliver a standard or tailored SMS (short message service) text message on the basis of timing of medication taking. Standard SMS text messages indicated that the smartphone app registered the button press, whereas tailored SMS text messages encouraged habit formation and systems thinking on the basis of the timing the medications were taken. Methods: A convenience sample of 5 adults with chronic kidney disease (CKD), who were prescribed antihypertensive medication, participated in a 52-day longitudinal study. The study was conducted in 3 phases, with a standard SMS text message sent in phases 1 (study days 1-14) and 3 (study days 46-52) and tailored SMS text messages sent during phase 2 (study days 15-45) in response to participant medication self-tracking. Medication adherence was measured using: (1) the smart button and (2) electronic medication monitoring caps. Concordance between these 2 methods was evaluated using percentage of measurements made on the same day and occurring within ±5 min of one another. Acceptability was evaluated using qualitative feedback from participants. Results: A total of 5 patients with CKD, stages 1-4, were enrolled in the study, with the majority being men (60%), white (80%), and Hispanic/Latino (40%) of middle age (52.6 years, SD 22.49; range 20-70). The mHealth system was successfully initiated in the clinic setting for all enrolled participants. Of the expected 260 data points, 36.5% (n=95) were recorded with the smart button and 76.2% (n=198) with electronic monitoring. Concordant events (n=94), in which events were recorded with both the smart button and electronic monitoring, occurred 47% of the time and 58% of these events occurred within ±5 min of one another. Participant comments suggested SMS text messages were encouraging. Conclusions: It was feasible to recruit participants in the clinic setting for an mHealth study, and our system was successfully initiated for all enrolled participants. The smart button is an innovative way to self-report adherence data, including date and timing of medication taking, which were not previously available from measures that rely on recall of adherence. Although the selected smart button had poor concordance with electronic monitoring caps, participants were willing to use it to self-track medication adherence, and they found the mHealth system acceptable to use in most cases. %M 31237568 %R 10.2196/13558 %U http://formative.jmir.org/2019/2/e13558/ %U https://doi.org/10.2196/13558 %U http://www.ncbi.nlm.nih.gov/pubmed/31237568 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13633 %T Exploring the Potential for Use of Virtual Reality Technology in the Treatment of Severe Mental Illness Among Adults in Mid-Norway: Collaborative Research Between Clinicians and Researchers %A Ose,Solveig Osborg %A Færevik,Hilde %A Kaasbøll,Jannike %A Lindgren,Martin %A Thaulow,Kristin %A Antonsen,Stig %A Burkeland,Olav %+ SINTEF AS Digital, Klaebuveien 153, Trondheim,, Norway, 47 90728684, solveig.ose@sintef.no %K virtual reality %K severe mental illness %K collaborative research %K technology %K social work %D 2019 %7 10.6.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Virtual reality (VR) technology is not currently used in the treatment of severe mental health illness in Norway. Objective: We aimed to explore the potential of VR as a treatment for severe mental health illness in Norway, through collaborative research between clinicians and researchers. Methods: A collaborative research team was established, comprising researchers, the manager at a district psychiatric center, and the manager of the local municipal mental health service. An all-day workshop with eight clinicians—four from specialist mental health services and four from municipal mental health services—was conducted. The clinicians watched three different VR movies and after each one, they answered predefined questions designed to reflect their immediate thoughts about VR’s potential use in clinical practice. At the end of the workshop, two focus group interviews, each with four clinicians from each service level, were conducted. Results: VR technology in specialist services might be a new tool for the treatment of severe mental health illness. In municipal mental health services, VR might particularly be useful in systematic social training that would otherwise take a very long time to complete. Conclusions: We found substantial potential for the use of VR in the treatment of severe mental health illness in specialist and municipal mental health services. One of the uses of VR technology with the greatest potential was helping individuals who had isolated themselves and needed training in social skills and everyday activity to enable them to have more active social lives. VR could also be used to simulate severe mental illness to provide a better understanding of how the person with severe mental illness experiences their situation. %M 31199315 %R 10.2196/13633 %U http://formative.jmir.org/2019/2/e13633/ %U https://doi.org/10.2196/13633 %U http://www.ncbi.nlm.nih.gov/pubmed/31199315 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13916 %T Independent and Web-Based Advice for Infertile Patients Using Fertility Consult: Pilot Study %A Huppelschoten,Aleida Gerarda %A de Bruin,Jan Peter %A Kremer,Jan AM %+ Department of Obstetrics and Gynaecology, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500 HB, Netherlands, 31 615339787, dana.huppelschoten@radboudumc.nl %K patient-centered care %K remote consultation %K decision making %K telemedicine %D 2019 %7 04.06.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient-centered care—that is, care tailored to personal wishes and needs of patients—has become increasingly important. It is especially relevant in health care areas where patients suffer from a high burden of disease, such as fertility care. At present, both diagnosis and treatment for infertile couples is provided at a single hospital. As a consequence, patients are not likely to receive optimal, independent advice regarding their fertility problems. Internet-based, independent advice could be feasible for large groups of patients because it is not limited by travel distance and overhead costs. Objective: The aim of this study was to explore the experiences of both patients and professionals with an online platform using video consultations for patients with infertility seeking independent advice for their fertility problem. Methods: This pilot study evaluated an online platform, Fertility Consult, where patients with infertility can get independent advice by a gynecologist through a video consultation, thus eliminating the need of meeting the doctor physically. Semistructured interviews were performed with 2 gynecologists and the chairman of the Dutch patients association. This information was used for a patients’ questionnaire about their first experiences with Fertility Consult, including questions about the level of patient-centeredness and shared decision making, using the Patient-Centered Questionnaire-Infertility (PCQ-Infertility) and the CollaboRATE questionnaire, respectively. Results: Of the first 27 patients enrolled at Fertility Consult, 22 responded (82%). Most patients (82%) visited Fertility Consult for a second opinion, seeking more personal attention and independent advice. The mean level of patient-centeredness on the PCQ-Infertility questionnaire was 2.78 (SD 0.58) on a scale of 0 to 3. For the CollaboRATE questionnaire (scale 0-9), patients provided a median score of 8.0 (range 7-9) on all 3 questions about shared decision making. Conclusions: Patients were satisfied with independent, well-prepared, Web-based advice; health care professionals felt they were able to provide patients with proper advice in a manner befitting patients’ needs, without any loss of quality. Future studies should focus more on the separation of advice and treatment and on Web-based consultations compared with face-to-face consultations to ascertain the possibility of increased patient involvement in the process to improve the level of patient-centered care. %M 31165714 %R 10.2196/13916 %U http://formative.jmir.org/2019/2/e13916/ %U https://doi.org/10.2196/13916 %U http://www.ncbi.nlm.nih.gov/pubmed/31165714 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12550 %T A Peer-Led Electronic Mental Health Recovery App in a Community-Based Public Mental Health Service: Pilot Trial %A Gulliver,Amelia %A Banfield,Michelle %A Morse,Alyssa R %A Reynolds,Julia %A Miller,Sarah %A Galati,Connie %+ Centre for Mental Health Research, Research School of Population Health, The Australian National University, 63 Eggleston Road, Acton, ACT, Canberra, 2601, Australia, 61 261259472, amelia.gulliver@anu.edu.au %K peer work %K computers, handheld %K pilot study %K mental health recovery %K mental health services, community %K mental disorders %D 2019 %7 04.06.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an increasing need for peer workers (people with lived experience of mental health problems who support others) to work alongside consumers to improve recovery and outcomes. In addition, new forms of technology (tablet or mobile apps) can deliver services in an engaging and innovative way. However, there is a need to evaluate interventions in real-world settings. Objective: This exploratory proof-of-concept study aimed to determine if a peer worker–led electronic mental health (e-mental health) recovery program is a feasible, acceptable, and effective adjunct to usual care for people with moderate-to-severe mental illness. Methods: Overall, 6 consumers and 5 health service staff participated in the evaluation of a peer-led recovery app delivered at a community-based public mental health service. The peer worker and other health professional staff invited attendees at the drop-in medication clinics to participate in the trial during June to August 2017. Following the intervention period, participants were also invited by the peer worker to complete the evaluation in a separate room with the researcher. Consumers were explicitly informed that participation in the research evaluation was entirely voluntary. Consumer evaluation measures at postintervention included recovery and views on the acceptability of the program and its delivery. Interviews with staff focused on the acceptability and feasibility of the app itself and integrating a peer worker into the health care service. Results: Consumer recruitment in the research component of the study (n=6) fell substantially short of the target number of participants (n=30). However, from those who participated, both staff and consumers were highly satisfied with the peer worker and somewhat satisfied with the app. Health care staff overall believed that the addition of the peer worker was highly beneficial to both the consumers and staff. Conclusions: The preliminary findings from this proof-of-concept pilot study suggest that a peer-led program may be a feasible and acceptable method of working on recovery in this population. However, the e-mental health program did not appear feasible in this setting. In addition, recruitment was challenging in this particular group, and it is important to note that these study findings may not be generalizable. Despite this, ensuring familiarity of technology in the target population before implementing e-mental health interventions is likely to be of benefit. %M 31165708 %R 10.2196/12550 %U http://formative.jmir.org/2019/2/e12550/ %U https://doi.org/10.2196/12550 %U http://www.ncbi.nlm.nih.gov/pubmed/31165708 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 6 %P e12940 %T iCanCope With Pain: Cultural Adaptation and Usability Testing of a Self-Management App for Adolescents With Persistent Pain in Norway %A Grasaas,Erik %A Fegran,Liv %A Helseth,Sølvi %A Stinson,Jennifer %A Martinez,Santiago %A Lalloo,Chitra %A Haraldstad,Kristin %+ Department of Health and Nursing Science, Faculty of Health and Sport Sciences, University of Agder, Universitetsveien 25, Kristiansand, 4630, Norway, 47 97524422, erik.grasaas@uia.no %K health %K self-management %K adolescent %K chronic pain %K translating %K mobile app %D 2019 %7 03.06.2019 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Persistent or chronic pain is a common health problem among adolescents. Thus, it is important that they receive evidence-based strategies for symptom management. iCanCope with Pain is a mobile phone app designed to help adolescents cope with chronic pain. The app comprises 5 evidence- and theory-based features: (I) symptom trackers for pain, sleep, mood, physical function, and energy; (II) goal setting to improve pain and function; (III) a coping toolbox of pain self-management strategies; (IV) social support; and (V) age-appropriate pain education. The iCanCope with Pain app is based on theory, identified health care needs, and current best practices for pain self-management. Objective: The objectives of this study were to describe the translation and cultural adaptation of the app into the Norwegian context and evaluate the app’s usability using a phased approach. Methods: Phase 1 included translation and cultural adaptation of the app into the Norwegian context. This process used an expert panel of researchers and target group representatives who were responsible for the linguistic quality assurance and assessment. In phases 2 and 3 the app’s usability was tested. For phase 2, the assessments of usability and user experiences included observation, the think aloud method, audiovisual recordings, questionnaires, and individual interviews in a laboratory setting. For phase 3, the assessment of usability and user experience over a 2-week home-based test included questionnaires and individual end-user interviews. Overall, app usability was determined based on ease of use, efficiency, and user satisfaction. Qualitative data were analyzed using deductive content analysis. Descriptive statistics were calculated for quantitative data. Results: End users did not report any misunderstandings or discrepancies with the words or phrasing of the translated and culturally adapted app. Participants in both the laboratory- and home-based usability tests found the app self-explanatory and reported that all 5 of its features were easy to use. All tasks were completed within the allocated time frame (ie, efficiency), with few errors. Overall System Usability Scale scores were high, with average scores of 82 and 89 out of 100 from laboratory- and field-based tests, respectively. Participants liked the idea of a social support function (feature IV), although qualitative and internet server data revealed that this feature was rarely used. Conclusions: This study described the cultural and linguistic adaptation and usability testing of the Norwegian version of the iCanCope with Pain app. High user satisfaction, ease of use, efficiency, and only minor errors cumulatively indicated that no changes to the app were needed, with the exception of facilitating user interaction within the social support feature. The app will be used in an upcoming randomized controlled trial with a larger sample. %M 31162132 %R 10.2196/12940 %U https://www.researchprotocols.org/2019/6/e12940/ %U https://doi.org/10.2196/12940 %U http://www.ncbi.nlm.nih.gov/pubmed/31162132 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e9995 %T Utilization of an Animated Electronic Health Video to Increase Knowledge of Post- and Pre-Exposure Prophylaxis for HIV Among African American Women: Nationwide Cross-Sectional Survey %A Bond,Keosha T %A Ramos,S Raquel %+ Department of Public Health, New York Medical College, 40 Sunshine Cottage Road, Valhalla, NY, 10595, United States, 1 594 2830, kbond@nymc.edu %K eHealth interventions %K heterosexual %K African American women %K HIV risk behaviors, HIV prevention %K entertainment-education %K postexposure prophylaxis %K pre-exposure prophylaxis %K internet %K videos %D 2019 %7 29.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite renewed focus on biomedical prevention strategies since the publication of several clinical trials highlighting the efficacy of pre-exposure prophylaxis (PrEP), knowledge of postexposure prophylaxis (PEP) and PrEP continues to remain scarce among women, especially among African American women who are disproportionally affected by HIV. In an effort to address this barrier and encourage uptake of PEP and PrEP, an electronic health (eHealth) video was created using an entertainment-education format. Objective: The study aimed to explore the feasibility, acceptability, and preference of an avatar-led, eHealth video, PEP and PrEP for Women, to increase awareness and knowledge of PEP and PrEP for HIV in a sample of African American women. Methods: A cross-sectional, Web-based study was conducted with 116 African American women aged 18 to 61 years to measure participants’ perceived acceptability of the video on a 5-point scale: poor, fair, good, very good, and excellent. Backward stepwise regression was used to the find the outcome variable of a higher rating of the PEP and PrEP for Women video. Thematic analysis was conducted to explore the reasons for recommending the video to others after watching the eHealth video. Results: Overall, 89% of the participants rated the video as good or higher. A higher rating of the educational video was significantly predicted by: no current use of drugs/alcohol (beta=−.814; P=.004), not having unprotected sex in the last 3 months (beta=−.488; P=.03), higher income (beta=.149; P=.03), lower level of education (beta=−.267; P=.005), and lower exposure to sexual assault since the age of 18 years (beta=−.313; P=.004). After watching the eHealth video, reasons for recommending the video included the video being educational, entertaining, and suitable for women. Conclusions: Utilization of an avatar-led eHealth video fostered education about PEP and PrEP among African American women who have experienced insufficient outreach for biomedical HIV strategies. This approach can be leveraged to increase awareness and usage among African American women. %M 31144667 %R 10.2196/formative.9995 %U http://formative.jmir.org/2019/2/e9995/ %U https://doi.org/10.2196/formative.9995 %U http://www.ncbi.nlm.nih.gov/pubmed/31144667 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e10388 %T Connecting Home-Based Self-Monitoring of Blood Pressure Data Into Electronic Health Records for Hypertension Care: A Qualitative Inquiry With Primary Care Providers %A Rodriguez,Sarah %A Hwang,Kevin %A Wang,Jing %+ School of Nursing, The University of Texas Health Science Center at San Antonio, MSC 7851, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States, 1 210 450 8561, wangj1@uthscsa.edu %K patient-generated health data %K connected health %K remote monitoring %K electronic health record %K hypertension %K patient reported outcome %K self-measured blood pressure %K self-monitoring of blood pressure %D 2019 %7 23.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a lack of research on how to best incorporate home-based self-measured blood pressure (SMBP) measurements, combined with other patient-generated health data (PGHD), into electronic health record (EHR) systems in a way that promotes primary care workflow without burdening the primary care team with irrelevant or superfluous data. Objective: The purpose of this study was to explore the perspectives of primary care providers in utilizing SMBP measurements and integrating SMBP data into the clinical workflow for the management of hypertension in the primary care setting. Methods: A total of 13 primary care physicians were interviewed in total; 5 in individual interviews and 8 in a focus group. The interview questions were centered on (1) the value of SMBP in hypertension care, (2) needs of viewing SMBP and desired visual display, (3) desired alert algorithm and critical values, (4) needs for other PGHD, and (5) workflow of primary care team in utilizing SMBP. The interviews were audiotaped and transcribed verbatim, and a thematic analysis was performed to extract overarching themes. Results: The primary care experience of the 13 providers ranged from 5 to 35 years. The following themes emerged from the individual and focus group interviews: (1) ways to utilize SMBP measurements in primary care, (2) preferred visual display of SMBP, (3) patient condition determines preferred scheduling of patient SMBP measurements and provider’s preferred frequency of viewing SMBP data, (4) effect of patient condition on alert parameters, (5) location to receive critical value alerts, (6) primary recipient of critical value alerts, and (7) the need of additional PGHD (eg, emotional stressors, food diary, and medication adherence) to provide context of SMBP values. Conclusions: The perspectives of primary care providers need to be incorporated into the design of a built-in interface in the EHR to incorporate SMBP and other PGHD. Future usability evaluation should be conducted with mock-up interfaces to solicit opinions on the optimal alert frequency and mechanism to best fit the workflow in the primary care setting. Future studies should examine how the utilization of a built-in interface that fully integrates SMBP measurements and PGHD into EHR systems can support patient self-management and thus, improve patient outcomes. %M 31124468 %R 10.2196/10388 %U http://formative.jmir.org/2019/2/e10388/ %U https://doi.org/10.2196/10388 %U http://www.ncbi.nlm.nih.gov/pubmed/31124468 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e10951 %T Digitizing a Face-to-Face Group Fatigue Management Program: Exploring the Views of People With Multiple Sclerosis and Health Care Professionals Via Consultation Groups and Interviews %A Thomas,Sarah %A Pulman,Andy %A Thomas,Peter %A Collard,Sarah %A Jiang,Nan %A Dogan,Huseyin %A Davies Smith,Angela %A Hourihan,Susan %A Roberts,Fiona %A Kersten,Paula %A Pretty,Keith %A Miller,Jessica K %A Stanley,Kirsty %A Gay,Marie-Claire %+ Bournemouth University Clinical Research Unit, Faculty of Health & Social Sciences, Bournemouth University, R506, Royal London House, Bournemouth,, United Kingdom, 44 1202961953, saraht@bournemouth.ac.uk %K multiple sclerosis %K fatigue %K telemedicine %K mobile health %K FACETS %K fatigue management %D 2019 %7 22.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Fatigue is one of the most common and debilitating symptoms of multiple sclerosis (MS) and is the main reason why people with MS stop working early. The MS Society in the United Kingdom funded a randomized controlled trial of FACETS—a face-to-face group-based fatigue management program for people with multiple sclerosis (pwMS)—developed by members of the research team. Given the favorable trial results and to help with implementation, the MS Society supported the design and printing of the FACETS manual and materials and the national delivery of FACETS training courses (designed by the research team) for health care professionals (HCPs). By 2015 more than 1500 pwMS had received the FACETS program, but it is not available in all areas and a face-to-face format may not be suitable for, or appeal to, everyone. For these reasons, the MS Society funded a consultation to explore an alternative Web-based model of service delivery. Objective: The aim of this study was to gather views about a Web-based model of service delivery from HCPs who had delivered FACETS and from pwMS who had attended FACETS. Methods: Telephone consultations were undertaken with FACETS-trained HCPs who had experience of delivering FACETS (n=8). Three face-to-face consultation groups were held with pwMS who had attended the FACETS program: London (n=4), Liverpool (n=4), and Bristol (n=7). The interviews and consultation groups were digitally recorded and transcribed. A thematic analysis was undertaken to identify key themes. Toward the end of the study, a roundtable meeting was held to discuss outcomes from the consultation with representatives from the MS Society, HCPs, and pwMS. Results: Key challenges and opportunities of designing and delivering an integrated Web-based version of FACETS and maintaining user engagement were identified across 7 themes (delivery, online delivery, design, group, engagement, interactivity, and HCP relationships). Particularly of interest were themes related to replicating the group dynamics and the lack of high-quality solutions that would support the FACETS’ weekly homework tasks and symptom monitoring and management. Conclusions: A minimum viable Web-based version of FACETS was suggested as the best starting point for a phased implementation, enabling a solution that could then be added to over time. It was also proposed that a separate study should look to create a free stand-alone digital toolkit focusing on the homework elements of FACETS. This study has commenced with a first version of the toolkit in development involving pwMS throughout the design and build stages to ensure a user-centered solution. %M 31120021 %R 10.2196/10951 %U http://formative.jmir.org/2019/2/e10951/ %U https://doi.org/10.2196/10951 %U http://www.ncbi.nlm.nih.gov/pubmed/31120021 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12635 %T Treatment Preferences for Internet-Based Cognitive Behavioral Therapy for Insomnia in Japan: Online Survey %A Sato,Daisuke %A Sutoh,Chihiro %A Seki,Yoichi %A Nagai,Eiichi %A Shimizu,Eiji %+ Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, 1-8-1, Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan, 81 43 226 2027, daisuke-sato@umin.ac.jp %K patient preference %K insomnia %K internet-based cognitive behavioral therapy %D 2019 %7 15.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The internet has the potential to increase individuals’ access to cognitive behavioral therapy (CBT) for insomnia at low cost. However, treatment preferences regarding internet-based computerized CBT for insomnia have not been fully examined. Objective: The aim was to conduct an anonymous online survey to evaluate treatment preferences for insomnia among patients with insomnia and individuals without insomnia. Methods: We developed an online survey to recruit a total of 600 participants living in the Kanto district in Japan. There were three subgroups: 200 medicated individuals with insomnia, 200 unmedicated individuals with insomnia, and 200 individuals without insomnia. The survey asked questions about the severity of the respondent’s insomnia (using the Athens Insomnia Scale), the frequency of sleep medication use and the level of satisfaction with sleep medication use, the respondent’s knowledge of CBT, his or her preference for CBT for insomnia before drug therapy, preference for CBT versus drug therapy, and preference for internet-based CBT versus face-to-face CBT. Results: Of the 600 respondents, 47.7% (286/600) indicated that they received CBT before drug therapy, and 57.2% (343/600) preferred CBT for insomnia to drug therapy. In addition, 47.0% (282/600) preferred internet-based CBT for insomnia to face-to-face CBT. Although the respondents with insomnia who were taking an insomnia medication had a relatively lower preference for internet-based CBT (40.5%, 81/200), the respondents with insomnia who were not taking an insomnia medication had a relatively higher preference for internet-based CBT (55.5%, 111/200). Conclusions: The results of our online survey suggest that approximately half of the people queried preferred CBT for insomnia to drug therapy, and half of the respondents preferred internet-based CBT for insomnia to face-to-face CBT. %M 31094319 %R 10.2196/12635 %U http://formative.jmir.org/2019/2/e12635/ %U https://doi.org/10.2196/12635 %U http://www.ncbi.nlm.nih.gov/pubmed/31094319 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13446 %T Internet-Based Cognitive Therapy for Social Anxiety Disorder in Hong Kong: Therapist Training and Dissemination Case Series %A Thew,Graham R %A Powell,Candice LYM %A Kwok,Amy PL %A Lissillour Chan,Mandy H %A Wild,Jennifer %A Warnock-Parkes,Emma %A Leung,Patrick WL %A Clark,David M %+ Department of Experimental Psychology, University of Oxford, The Old Rectory, Paradise Square, Oxford, OX1 1TW, United Kingdom, 44 01865 618600, graham.thew@psy.ox.ac.uk %K anxiety %K social phobia %K internet %K cognitive therapy %K clinical competence %K cross-cultural comparison %K Hong Kong %K benchmarking %K psychology, clinical %K mental health %D 2019 %7 15.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Guided internet-based psychological interventions show substantial promise for expanding access to evidence-based mental health care. However, this can only be achieved if results of tightly controlled studies from the treatment developers can also be achieved in other independent settings. This dissemination depends critically on developing efficient and effective ways to train professionals to deliver these interventions. Unfortunately, descriptions of therapist training and its evaluation are often limited or absent within dissemination studies. Objective: This study aimed to describe and evaluate a program of therapist training to deliver internet-based Cognitive Therapy for social anxiety disorder (iCT-SAD). As this treatment was developed in the United Kingdom and this study was conducted in Hong Kong with local therapists, an additional objective was to examine the feasibility, acceptability, and initial efficacy of iCT-SAD in this cultural context, based on data from a pilot case series. Methods: Training in iCT-SAD was provided to 3 therapists and included practice of the face-to-face format of therapy under clinical supervision, training workshops, and treating 6 patients with the iCT-SAD program. Training progress was evaluated using standardized and self-report measures and by reviewing patient outcomes. In addition, feedback from patients and therapists was sought regarding the feasibility and acceptability of the program. Results: The training program was effective at increasing therapists’ iCT-SAD knowledge and skills, resulting in levels of competence expected of a specialist Cognitive Behavioral Therapy practitioner. The 6 patients treated by the trainees all completed their treatment and achieved a mean pre- to posttreatment change of 53.8 points (SD 39.5) on the primary patient outcome measure, the Liebowitz Social Anxiety Scale. The within-group effect size (Cohen d) was 2.06 (95% CI 0.66-3.46). There was evidence to suggest that the patients’ clinical outcomes were sustained at 3-month follow-up. These clinical results are comparable to those achieved by UK patients treated by the developers of the internet program. Patient and therapist feedback did not identify any major cultural barriers to implementing iCT-SAD in Hong Kong; some modest language suggestions were made to assist understanding. Conclusions: The therapist training implemented here facilitated the successful dissemination of an effective UK-developed internet intervention to Hong Kong. The treatment appeared feasible and acceptable in this setting and showed highly promising initial efficacy. A randomized controlled trial is now required to examine this more robustly. As therapist training is critical to the successful dissemination of internet interventions, further research to develop, describe, and evaluate therapist training procedures is recommended. %M 31094320 %R 10.2196/13446 %U http://formative.jmir.org/2019/2/e13446/ %U https://doi.org/10.2196/13446 %U http://www.ncbi.nlm.nih.gov/pubmed/31094320 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 2 %P e12664 %T EasyDetectDisease: An Android App for Early Symptom Detection and Prevention of Childhood Infectious Diseases %A Ponum,Mahvish %A Hasan,Osman %A Khan,Saadia %+ School of Electrical Engineering and Computer Science, National University of Sciences and Technology, Islamabad, Pakistan, Islamabad, 440000, Pakistan, 92 3067826262, mponum.msit15seecs@seecs.edu.pk %K infectious diseases %K mHealth %K causes of death %D 2019 %7 14.05.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Infectious diseases often lead to death among children under 5 years in many underdeveloped and developing countries. One of the main reasons behind this is an unawareness of disease symptoms among mothers and child caregivers. To overcome this, we propose the EasyDetectDisease mobile health app to educate mothers about the early symptoms of pediatric diseases and to provide them with practical advice for preventing the spread of such diseases in children under 5 years. The EasyDetectDisease app includes detailed knowledge of infectious diseases, including the corresponding symptoms, causes, incubation period, preventive measures, nutritional guidelines such as breastfeeding, video tutorials of child patients, and video guidelines by pediatric health experts to promote child health. It also provides information on the diagnosis of the infectious diseases based on symptoms. Objective: The objective of this study was to evaluate the usability (eg, ease of use, easy detection of disease, functionality, and navigation of interfaces) of the EasyDetectDisease app among mothers of children under 5 years of age. Methods: Two health sessions, held in Pakistan, were used to evaluate the usability of EasyDetectDisease by 30 mothers of children under 5 years. The app was evaluated based on various quantitative and qualitative measures. Results: The participating mothers confirmed that they were able to diagnose diseases accurately and that after following the instructions provided, their children recovered rapidly without any nutritional deficiency. All participating mothers showed an interest in using the EasyDetectDisease app if made available by governmental public health agencies, and they suggested its inclusion in all mobile phones as a built-in health app in the future. Conclusions: EasyDetectDisease was modified into a user-friendly app based on feedback collected during the usability sessions. All participants found it acceptable and easy to use, especially illiterate mothers. The EasyDetectDisease app proved to be a useful tool for child health care at home and for the treatment of infectious diseases and is expected to reduce the mortality rate of children under 5 years of age. %M 31094329 %R 10.2196/12664 %U http://www.i-jmr.org/2019/2/e12664/ %U https://doi.org/10.2196/12664 %U http://www.ncbi.nlm.nih.gov/pubmed/31094329 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13882 %T Feasibility and Acceptability of Using a Mobile Phone App for Characterizing Auditory Verbal Hallucinations in Adolescents With Early-Onset Psychosis: Exploratory Study %A Smelror,Runar Elle %A Bless,Josef Johann %A Hugdahl,Kenneth %A Agartz,Ingrid %+ Department of Psychiatric Research, Diakonhjemmet Hospital, PO Box 85 Vinderen, Oslo, 0319, Norway, 47 95744029, runar.smelror@medisin.uio.no %K experience sampling method %K ecological momentary assessment %K schizophrenia %K mHealth %K health care technology %D 2019 %7 14.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Auditory verbal hallucinations (AVH) are the most frequent symptom in early-onset psychosis (EOP) and a risk factor for increased suicide attempts in adolescents. Increased knowledge of AVH characteristics can lead to better prediction of risk and precision of diagnosis and help identify individuals with AVH who need care. As 98% of Norwegian adolescents aged 12 to 16 years own a mobile phone, the use of mobile phone apps in symptom assessment and patient communication is a promising new tool. However, when introducing new technology to patients, their subjective experiences are crucial in identifying risks, further development, and potential integration into clinical care. Objective: The objective was to explore the feasibility and acceptability of a newly developed mobile phone app in adolescents with EOP by examining compliance with the app and user experiences. Indication of validity was explored by examining associations between AVH dimensions, which were correlated and analyzed. Methods: Three adolescents with EOP and active AVH were enrolled. Real-time AVH were logged on an iPod touch using the experience sampling method (ESM), for seven or more consecutive days. The app included five dimensions of AVH characteristics and was programmed with five daily notifications. Feasibility and acceptability were examined using the mean response rate of data sampling and by interviewing the participants. Validity was assessed by examining associations between the AVH dimensions using nonparametric correlation analysis and by visual inspection of temporal fluctuations of the AVH dimensions. Results: One participant was excluded from the statistical analyses but completed the interview and was included in the examination of acceptability. The sampling period of the two participants was mean 12 (SD 6) days with overall completed sampling rate of 74% (SD 30%), indicating adequate to high compliance with the procedure. The user experiences from the interviews clustered into four categories: (1) increased awareness, (2) personal privacy, (3) design and procedure, and (4) usefulness and clinical care. One participant experienced more commenting voices during the sampling period, and all three participants had concerns regarding personal privacy when using electronic devices in symptom assessment. The AVH dimensions of content, control, and influence showed moderate to strong significant correlations with all dimensions (P<.001). Days of data sampling showed weak to moderate correlations with localization (P<.001) and influence (P=.03). Visual inspection indicated that the app was able to capture fluctuations within and across days for all AVH dimensions. Conclusions: This study demonstrates the value of including patients’ experiences in the development and pilot-testing of new technology. Based on the small sample size, the use of mobile phones with ESM seems feasible for patients with EOP, but the acceptability of using apps should be considered. Further investigation with larger samples is warranted before definitive conclusions are made. %M 31094321 %R 10.2196/13882 %U http://formative.jmir.org/2019/2/e13882/ %U https://doi.org/10.2196/13882 %U http://www.ncbi.nlm.nih.gov/pubmed/31094321 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e12426 %T Design Choices and Trade-Offs in Health Care Blockchain Implementations: Systematic Review %A O'Donoghue,Odhran %A Vazirani,Anuraag A %A Brindley,David %A Meinert,Edward %+ Healthcare Translation Research Group, Department of Paediatrics, University of Oxford, Level 2, Children's Hospital, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, 44 7824446808, edward.meinert@paediatrics.ox.ac.uk %K blockchain %K interoperability %K distributed ledger technology %K scalability %K health information exchange %D 2019 %7 10.05.2019 %9 Review %J J Med Internet Res %G English %X Background: A blockchain is a list of records that uses cryptography to make stored data immutable; their use has recently been proposed for electronic medical record (EMR) systems. This paper details a systematic review of trade-offs in blockchain technologies that are relevant to EMRs. Trade-offs are defined as “a compromise between two desirable but incompatible features.” Objective: This review’s primary research question was: “What are the trade-offs involved in different blockchain designs that are relevant to the creation of blockchain-based electronic medical records systems?” Methods: Seven databases were systematically searched for relevant articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Papers published from January 1, 2017 to June 15, 2018 were selected. Quality assessments of papers were performed using the Risk Of Bias In Non-randomized Studies—of Interventions (ROBINS-I) tool and the Critical Assessment Skills Programme (CASP) tool. Database searches identified 2885 articles, of which 15 were ultimately included for analysis. Results: A total of 17 trade-offs were identified impacting the design, development, and implementation of blockchain systems; these trade-offs are organized into themes, including business, application, data, and technology architecture. Conclusions: The key findings concluded the following: (1) multiple trade-offs can be managed adaptively to improve EMR utility; (2) multiple trade-offs involve improving the security of blockchain systems at the cost of other features, meaning EMR efficacy highly depends on data protection standards; and (3) multiple trade-offs result in improved blockchain scalability. Consideration of these trade-offs will be important to the specific environment in which electronic medical records are being developed. This review also uses its findings to suggest useful design choices for a hypothetical National Health Service blockchain. International Registered Report Identifier (IRRID): RR2-10.2196/10994 %M 31094344 %R 10.2196/12426 %U https://www.jmir.org/2019/5/e12426/ %U https://doi.org/10.2196/12426 %U http://www.ncbi.nlm.nih.gov/pubmed/31094344 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13324 %T Young Adults’ Engagement With a Self-Monitoring App for Vegetable Intake and the Impact of Social Media and Gamification: Feasibility Study %A Nour,Monica %A Chen,Juliana %A Allman-Farinelli,Margaret %+ School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Level 4 EAST, Charles Perkins Centre D17 The University of Sydney, Camperdown, 2006, Australia, 61 403094095, mnou2973@uni.sydney.edu.au %K vegetables %K young adults %K mHealth %K social media %K experimental game %D 2019 %7 10.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media and gamification have been used in digital interventions for improving nutrition behaviors of young adults, but few studies measure engagement. Objective: This feasibility study aimed to explore user engagement with a 4-week smartphone program for improving vegetable intake. Methods: A goal setting and self-monitoring app was developed for feasibility testing. We assessed if additional components of gaming and/or social media support increased engagement. A 2 × 2 factorial study design was used with participants randomly allocated to each group. Engagement with the app (usage) was captured via inbuilt software, which recorded total days of app usage (duration) and the frequency of logging vegetable intake. Uptake of the social media (Facebook) content was measured by tracking views, likes, and comments on posts. Results: Out of the 110 potential participants who completed the prescreening questionnaire online, 97 were eligible (mean age 24.8 [SD 3.4]). In total, 49% (47/97) of participants were retained at 4 weeks. Attrition within the first week was the highest among users of the gamified app without social support (Facebook; P<.001). Over the intervention period, 64% (62/97) of participants logged into their app, with vegetable intake recorded on average for 11 out of 28 days. The frequency of recording decreased each week (mean 4 [SD 2] days in week 1 versus mean 2 [SD 2] days in week 4). No effects of gaming or social support on the frequency of recording vegetables or the duration of app engagement were found. However, regardless of the app type, the duration of app engagement was significantly associated with vegetable intake post intervention (P<.001). In total, 60% of Facebook posts were viewed by participants but engagement was limited to likes, with no comments or peer-to-peer interaction observed. Conclusions: As duration of usage was associated with vegetable intake, a deeper understanding of factors influencing engagement is needed. Dimensions such as personal attributes and the setting and context require further exploration in addition to content and delivery. %M 31094322 %R 10.2196/13324 %U http://formative.jmir.org/2019/2/e13324/ %U https://doi.org/10.2196/13324 %U http://www.ncbi.nlm.nih.gov/pubmed/31094322 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12132 %T An E-Learning Adaptation of an Evidence-Based Media Literacy Curriculum to Prevent Youth Substance Use in Community Groups: Development and Feasibility of REAL Media %A Ray,Anne E %A Greene,Kathryn %A Hecht,Michael L %A Barriage,Sarah C %A Miller-Day,Michelle %A Glenn,Shannon D %A Banerjee,Smita C %+ Department of Health Behavior, Society, and Policy, School of Public Health, Rutgers, The State University of New Jersey, 683 Hoes Lane West, Piscataway, NJ, 08854, United States, 1 732 235 5716, aer108@sph.rutgers.edu %K substance use %K prevention %K media literacy %K e-learning %K adaptation %D 2019 %7 09.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a need for evidence-based substance use prevention efforts that target high school-aged youth that are easy to implement and suitable for dissemination in school and community groups. The Youth Message Development (YMD) program is a brief, four-lesson, in-person curriculum that aims to prevent youth substance use through the development of youth media literacy. Specifically, YMD aims to increase understanding of advertising reach and costs, along with the techniques used to sell products; develop counterarguing and critical thinking skills in response to advertisements; and facilitate application of these skills to the development of youth-generated antisubstance messages. Although YMD has demonstrated evidence of success, it is limited by its delivery method and focus on alcohol and smoking. Objective: Study objectives were two-fold: (1) to adapt the YMD curriculum to a self-paced, interactive, electronic-learning (e-learning) format and expand its content to cover alcohol, combustible cigarettes, e-cigarettes, smokeless tobacco, marijuana, and prescription drugs, and (2) to test the feasibility of the adapted curriculum in partnership with a national youth organization. Methods: An iterative process was employed in partnership with the 4-H youth development organization and a technology developer and consisted of six phases: (1) focus groups to guide adaptation, (2) adaptation to an e-learning format renamed REAL media, (3) pilot-testing of the REAL media prototype to determine feasibility and acceptability, (4) program revisions, (5) usability testing of the revised prototype, and (6) final revisions. Focus groups and pilot and usability testing were conducted with 4-H youth club members and adult club leaders. Results: Focus group feedback guided the build of an e-learning prototype of REAL media, which consisted of five online levels and interactive content guided by a mix of narration and on-screen text. Results of a pilot test of the prototype were neutral to positive, and the program was refined based on end-user feedback. An independent usability test indicated that youth 4-H members felt favorably about navigating REAL media, and they reported high self-efficacy in applying skills learned in the program. Additional refinements to the program were made based on their feedback. Conclusions: The iterative build process involving the end user from the outset yielded an overall successful technology-driven adaptation of an evidence-based curriculum. This should increase the likelihood of effectively impacting behavioral outcomes as well as uptake within community organizations. %M 31094328 %R 10.2196/12132 %U http://formative.jmir.org/2019/2/e12132/ %U https://doi.org/10.2196/12132 %U http://www.ncbi.nlm.nih.gov/pubmed/31094328 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11890 %T Barriers and Facilitators for Implementing a Decision Support System to Prevent and Treat Disease-Related Malnutrition in a Hospital Setting: Qualitative Study %A Paulsen,Mari Mohn %A Varsi,Cecilie %A Paur,Ingvild %A Tangvik,Randi Julie %A Andersen,Lene Frost %+ National Advisory Unit on Disease-related Malnutrition, Department of Cancer Medicine, Oslo University Hospital, Sognsvannsveien 20, Oslo, 0372, Norway, 47 22851103, m.m.paulsen@medisin.uio.no %K malnutrition %K implementation science %K eHealth %K qualitative research %K decision support systems, clinical %D 2019 %7 09.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Disease-related malnutrition is a challenge among hospitalized patients. Despite guidelines and recommendations for prevention and treatment, the condition continues to be prevalent. The MyFood system is a recently developed decision support system to prevent and treat disease-related malnutrition. Objective: To investigate the possible implementation of the MyFood system in clinical practice, the aims of the study were (1) to identify current practice, routines, barriers, and facilitators of nutritional care; (2) to identify potential barriers and facilitators for the use of MyFood; and (3) to identify the key aspects of an implementation plan. Methods: A qualitative study was performed among nurses, physicians, registered dietitians, and middle managers in 2 departments in a university hospital in Norway. Focus group discussions and semistructured interviews were used to collect data. The Consolidated Framework for Implementation Research (CFIR) was used to create the interview guide and analyze the results. The transcripts were analyzed using a thematic analysis. Results: A total of 27 health care professionals participated in the interviews and focus groups, including nurses (n=20), physicians (n=2), registered dietitians (n=2), and middle managers (n=3). The data were analyzed within 22 of the 39 CFIR constructs. Using the 5 CFIR domains as themes, we obtained the following results: (1) Intervention characteristics: MyFood was perceived to have a relative advantage of being more trustworthy, systematic, and motivational and providing increased awareness of nutritional treatment compared with the current practice. Its lack of communication with the existing digital systems was perceived as a potential barrier; (2) Outer settings: patients from different cultural backgrounds with language barriers and of older age were potential barriers for the use of the MyFood system; (3) Inner settings: no culture for specific routines or systems related to nutritional care existed in the departments. However, tension for change regarding screening for malnutrition risk, monitoring and nutritional treatment was highlighted in all categories of interviewees; (4) Characteristics of the individuals: positive attitudes toward MyFood were present among the majority of the interviewees, and they expressed self-efficacy toward the perceived use of MyFood; (5) Process: providing sufficient information to everyone in the department was highlighted as key to the success of the implementation. The involvement of opinion leaders, implementation leaders, and champions was also suggested for the implementation plan. Conclusions: This study identified several challenges in the nutritional care of hospitalized patients at risk of malnutrition and deviations from recommendations and guidelines. The MyFood system was perceived as being more precise, trustworthy, and motivational than the current practice. However, several potential barriers were identified. The assessment of the current situation and the identification of perceived barriers and facilitators will be used in planning an implementation and effect study, including the creation of an implementation plan. %M 31094333 %R 10.2196/11890 %U http://formative.jmir.org/2019/2/e11890/ %U https://doi.org/10.2196/11890 %U http://www.ncbi.nlm.nih.gov/pubmed/31094333 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11364 %T The Use of Smart Technology in an Online Community of Patients With Degenerative Cervical Myelopathy %A Mowforth,Oliver Daniel %A Davies,Benjamin Marshall %A Kotter,Mark Reinhard %+ Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke's Hospital, University of Cambridge, Hills Road, Cambridge,, United Kingdom, 44 1223 763366, mrk25@cam.ac.uk %K spinal cord diseases %K cervical vertebrae %K spinal osteophytosis %K spondylosis %K biomedical technology %K chronic disease %K follow-up studies %D 2019 %7 09.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Degenerative cervical myelopathy (DCM) is a prevalent and progressively disabling neurological condition. Treatment is currently limited to surgery, the timing of which is not without controversy. New international guidelines recommend that all patients should undergo lifelong surveillance and those with moderate-to-severe or progressive disease should be offered surgery. Long-term surveillance will place substantial burden on health services and short clinic assessments may risk misrepresenting disease severity. The use of smart technology to monitor disease progression could provide an invaluable opportunity to lessen this burden and improve patient care. However, given the older demographic of DCM, the feasibility of smart technology use is unclear. Objective: The aim of this study was to investigate current usage of smart technology in patients with self-reported DCM to inform design of smart technology apps targeted at monitoring DCM disease progression. Methods: Google Analytics from the patient section of Myelopathy.org, an international DCM charity with a large online patient community, was analyzed over a 1-year period. A total of 15,761 sessions were analyzed. Results: In total, 39.6% (295/744) of visitors accessed the website using a desktop computer, 35.1% (261/744) using mobile, and 25.3% (188/744) using a tablet. Of the mobile and tablet visitors, 98.2% (441/449) utilized a touchscreen device. A total of 51.3% (141/275) of mobile and tablet visitors used iPhone Operating System (iOS) and 45.8% (126/275) used an Android operating system. Apple and Samsung were the most popular smart devices, utilized by 53.6% (241/449) and 25.8% (116/449) of visitors, respectively. The overall visitor age was representative of DCM trials. Smart technology was widely used by older visitors: 58.8% (113/192) of mobile visitors and 84.2% (96/114) of tablet visitors were aged 45 years or older. Conclusions: Smart technology is commonly used by DCM patients. DCM apps need to be iOS and Android compatible to be accessible to all patients. %M 31094330 %R 10.2196/11364 %U http://formative.jmir.org/2019/2/e11364/ %U https://doi.org/10.2196/11364 %U http://www.ncbi.nlm.nih.gov/pubmed/31094330 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12679 %T Feasibility of a Mobile Phone App to Promote Adherence to a Heart-Healthy Lifestyle: Single-Arm Study %A Lunde,Pernille %A Nilsson,Birgitta Blakstad %A Bergland,Astrid %A Bye,Asta %+ Department of Physiotherapy, Faculty of Health Sciences, Oslo Metropolitan University, P50, PB 4, St Olavs Plass, Oslo,, Norway, 47 48 06 35 37, plunde@oslomet.no %K mHealth %K eHealth %K mobile phone app %K cardiac rehabilitation %D 2019 %7 19.4.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Long-term maintenance of preventive activities is fundamental for achieving improved outcomes in cardiac rehabilitation (CR). Despite this, it has been shown to be a major challenge for many patients to follow recommendations and thereby adhere to a heart-healthy lifestyle. Mobile phone apps have been emphasized as potential tools to promote preventive activities after attendance in a CR program. Before commencing a trial to assess the potential effect of using an app to promote long-term adherence to preventive activities after attendance in CR, a study to assess if it is feasible to use an app is warranted. Objective: The goal of the research is to assess if it is feasible to use a mobile phone app for promoting and monitoring patients’ adherence to a heart-healthy lifestyle after CR. Methods: The study included an experimental, pre-post single-arm trial lasting for 12 weeks. All patients received access to an app aimed to guide individuals to change or maintain a heart-healthy lifestyle. During the study period, patients received weekly, individualized monitoring through the app, based on their own goals. Feasibility outcomes assessed were recruitment rate, adherence to the app, resource requirements, and efficacy regarding capability to detect a change in quality of life, health status, and perceived goal achievement as well as evaluating ceiling and floor effect in these outcomes. Criteria for success were preset to be able to evaluate whether the app was feasible to use in a potential future RCT. Results: In total, 71% (17/24) of the patients who completed CR were eligible for a potential RCT as well as for this study. All 14 patients included in the study used the app to promote preventive activities throughout the study. Satisfaction with the technology was high, and the patients found the technology-based follow-up intervention both useful and motivational. Ceiling effect was present in more than 20% of the patients in several domains of the questionnaires evaluating quality of life (36-Item Short Form Health Survey and COOP/WONCA functional health assessments) and health status (EQ-5D). Overall self-rated health status (EuroQol Visual Analog Scale) and perceived goal achievement were found to be outcomes able to detect a change. Conclusions: Individual follow-up through an app after attendance in CR is feasible. All patients used the app for preventive activities and found the app both useful and motivating. Several points of guidance from the patients in the study have been adopted and incorporated into the final design of the RCT now in the field. %M 31066684 %R 10.2196/12679 %U http://formative.jmir.org/2019/2/e12679/ %U https://doi.org/10.2196/12679 %U http://www.ncbi.nlm.nih.gov/pubmed/31066684 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12406 %T Considerations of Privacy and Confidentiality in Developing a Clinical Support Tool for Adolescent Tobacco Prevention: Qualitative Study %A Theis,Ryan P %A Malik,Ali M %A Thompson,Lindsay A %A Shenkman,Elizabeth A %A Pbert,Lori %A Salloum,Ramzi G %+ Institute for Child Health Policy, Department of Health Outcomes and Biomedical Informatics, University of Florida, 2004 Mowry Road, Suite 2252, Gainesville, FL, 32610, United States, 1 352 294 5973, rtheis@ufl.edu %K clinical decision support %K adolescent %K primary care %K tobacco use %K confidentiality %K implementation science %K qualitative research %D 2019 %7 28.4.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic clinical support tools show promise for facilitating tobacco screening and counseling in adolescent well-care. However, the application of support tools in pediatric settings has not been thoroughly studied. Successfully implementing support tools in local settings requires an understanding of barriers and facilitators from the perspective of both patients and providers. Objective: This paper aimed to present the findings of a qualitative study conducted to inform the development and implementation of a support tool for adolescent tobacco screening and counseling in 3 pediatric clinics in North Florida. The primary objective of the study was to test and collect information needed to refine a tablet-based support tool with input from patients and providers in the study clinics. Methods: A tablet prototype was designed to collect information from adolescents on tobacco susceptibility and use before their well-care visit and to present tobacco prevention videos based on their responses. Information collected from adolescents by the support tool would be available to providers during the visit to facilitate and streamline tobacco use assessment and counseling components of well-care. Focus groups with providers and staff from 3 pediatric clinics (n=24) identified barriers and facilitators to implementation of the support tool. In-depth interviews with racially and ethnically diverse adolescent patients who screened as susceptible to tobacco use (n=16) focused on acceptability and usability of the tool. All focus groups and interviews were audio-recorded and transcribed for team-based coding using thematic analysis. Results: Privacy and confidentiality of information was a salient theme. Both groups expressed concerns that the tool’s audio and visual components would impede privacy and that parents may read their child’s responses or exert control over the process. Nearly all adolescents stated they would be comfortable with the option to complete the tool at home via a Web portal. Most adolescents stated they would feel comfortable discussing tobacco with their doctor. Adolescent interviews elicited 3 emergent themes that added context to perspectives on confidentiality and had practical implications for implementation: (1) purity: an expressed lack of concern for confidentiality among adolescents with no reported history of tobacco use; (2) steadfast honesty: a commitment to being honest with parents and providers about tobacco use, regardless of the situation; and (3) indifference: a perceived lack of relevance of confidentiality, based on the premise that others will “find out anyway” if adolescents are using tobacco. Conclusions: This study informed several modifications to the intervention to address confidentiality and introduce efficiency to well-care visits. The support tool was integrated into the electronic health record system used by the study clinics and modified to offer videos to all adolescents regardless of their tobacco use or susceptibility. Future studies will further test the acceptability of the intervention in practice. %M 31066687 %R 10.2196/12406 %U http://formative.jmir.org/2019/2/e12406/ %U https://doi.org/10.2196/12406 %U http://www.ncbi.nlm.nih.gov/pubmed/31066687 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e13415 %T Web-Based Interventions to Improve Mental Health in Home Caregivers of People With Dementia: Meta-Analysis %A Zhao,Yinan %A Feng,Hui %A Hu,Mingyue %A Hu,Hengyu %A Li,Hui %A Ning,Hongting %A Chen,Huijing %A Liao,Lulu %A Peng,Linlin %+ Xiangya School of Nursing, Central South University, No 172 Tongzipo Road, Changsha,, China, 86 82650292, feng.hui@csu.edu.cn %K internet %K education %K mental health %K caregivers %K dementia %D 2019 %7 6.5.2019 %9 Review %J J Med Internet Res %G English %X Background: Dementia is a major cause of disability and dependency in older adults worldwide. It is often accompanied by general psychological distress, such as depression and anxiety symptoms, among caregivers of people with dementia (PwD). The physical and mental health of the caregiver is a prerequisite and a promise to help PwD continue to live as long and as well as possible. Web-based interventions can provide convenient and efficient support and an education tool to potentially reduce the negative outcomes associated with providing care. Objective: The aim of this study was to examine the effect of internet-based interventions on the mental health outcomes of family caregivers of PwD and to explore which components of the Web-based interventions play an important role. Methods: A comprehensive literature search was conducted in PubMed, Excerpta Medica dataBASE, PsycINFO, Cochrane Database, and the Cumulative Index to Nursing and Allied Health Literature using relevant terms such as Web-based and caregiver as keywords, covering all studies published before June 2018. A total of 2 reviewers independently reviewed all published abstracts, according to established inclusion and exclusion criteria. We extracted information about the participants, interventions, and results and reviewed article quality in terms of the randomized trial methods, using the approach recommended by the Cochrane Handbook for Systematic Reviews of Interventions. Results: A total of 815 caregivers participated in 6 studies, with 4 of the studies using depression as an outcome. The analysis found that depression scores dropped an average of 0.23 (95% CI −0.38 to −0.07; P<.01) after Web-based interventions. In 2 studies of caregivers who were experiencing anxiety symptoms, the average score for anxiety dropped by 0.32 points (95% CI −0.50 to −0.14; P<.01). However, in terms of coping, pain, and stress, the Web-based interventions showed a poor effect. On the whole, the addition of professional psychological support on the basis of education can improve caregivers’ mental health. Conclusions: Internet-based interventions were generally effective at reducing anxiety and depression in dementia caregivers, although negative results were found in some studies. As for burden and stress, further research is required. %M 31066680 %R 10.2196/13415 %U http://www.jmir.org/2019/5/e13415/ %U https://doi.org/10.2196/13415 %U http://www.ncbi.nlm.nih.gov/pubmed/31066680 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11958 %T The Implementation of an mHealth Intervention (ReZone) for the Self-Management of Overwhelming Feelings Among Young People %A Edridge,Chloe %A Deighton,Jessica %A Wolpert,Miranda %A Edbrooke-Childs,Julian %+ Anna Freud National Centre for Children and Families, 12 Maresfield Gardens, London, NW3 5SU, United Kingdom, 44 020 7433 6191, chloe.edridge@annafreud.org %K cluster trial %K behavioural difficulties %K schools %K mHealth, digital %K mental health %K mobile phone %D 2019 %7 02.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The association between mental health difficulties and academic attainment is well established. There is increasing research on mobile health (mHealth) interventions to provide support for the mental health and education of young people. However, nonadoption and inadequate implementation of mHealth interventions are prevalent barriers to such trials. Objective: The aim of this study was to bridge this gap and examine the implementation of an mHealth intervention, ReZone, for young people in schools. Methods: Preliminary data for 79 students collected as part of a larger trial were analyzed. We additionally conducted postimplementation consultations with teachers. Results: ReZone was used 1043 times by 36 students in the intervention arm during the study period. Postimplementation teacher consultations provided data on implementation strategies, barriers, and facilitators. Conclusions: Implementation strategies, barriers, and facilitators for digital interventions need to be considered to limit nonadoption and inadequate implementation in larger trials. Important considerations involve tailoring the characteristics of the intervention to the requirements of the intended user group, the technology itself, and the organization in which it is implemented. Trial Registration: International Standard Randomised Controlled Trial Number: 13425994; http://www.isrctn.com/ISRCTN13425994 %M 31045499 %R 10.2196/11958 %U http://formative.jmir.org/2019/2/e11958/ %U https://doi.org/10.2196/11958 %U http://www.ncbi.nlm.nih.gov/pubmed/31045499 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11242 %T An Intervention to Increase Condom Use Among Users of Chlamydia Self-Sampling Websites (Wrapped): Intervention Mapping and Think-Aloud Study %A Newby,Katie %A Crutzen,Rik %A Brown,Katherine %A Bailey,Julia %A Saunders,John %A Szczepura,Ala %A Hunt,Jonny %A Alston,Tim %A Sadiq,S Tariq %A Das,Satyajit %+ Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences, Coventry University, RC Building (4th Floor), Priory St, Coventry, CV1 5FB, United Kingdom, 44 02477 657459, k.newby@coventry.ac.uk %K sexually transmitted infection %K condoms %K sexual behavior %K young adult %K intervention development %K internet %K eHealth %K co-design %D 2019 %7 01.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Young people aged 16-24 years are disproportionately affected by sexually transmitted infections (STIs). STIs can have serious health consequences for affected individuals and the estimated annual cost of treatment to the National Health Service is £620 million. Accordingly, the UK government has made reducing the rates of STIs among this group a priority. A missed opportunity to intervene to increase condom use is when young people obtain self-sampling kits for STIs via the internet. Objective: Our aim was to develop a theory-based tailored intervention to increase condom use for 16-24-years-olds accessing chlamydia self-sampling websites. Methods: The intervention, Wrapped, was developed using Intervention Mapping and was co-designed with young people. The following steps were performed: (1) identification of important determinants of condom use and evidence of their changeability using computer and digital interventions; (2) setting the intervention goal, performance objectives, and change objectives; (3) identification of Behavior Change Principles (BCPs) and practical strategies to target these determinants; and (4) development of intervention materials able to deliver the BCPs and practical strategies. Results: Users of existing chlamydia self-sampling websites are signposted to Wrapped after placing an order for a sampling kit. Salient barriers to condom use are identified by each user and relevant intervention components are allocated to target these. The components include the following: (1) a sample box of condoms, (2) an online condom distribution service, (3) a product for carrying condoms, (4) a condom demonstration video, (5) a series of videos on communication about condom use, and (6) erotic films of real couples discussing and demonstrating condom use. Conclusions: This intervention will be directed at young people who may be particularly receptive to messages and support for behavior change due to their testing status. %M 31042156 %R 10.2196/11242 %U http://formative.jmir.org/2019/2/e11242/ %U https://doi.org/10.2196/11242 %U http://www.ncbi.nlm.nih.gov/pubmed/31042156 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11586 %T Feasibility Randomized Controlled Trial of ImpulsePal: Smartphone App–Based Weight Management Intervention to Reduce Impulsive Eating in Overweight Adults %A van Beurden,Samantha B %A Smith,Jane R %A Lawrence,Natalia S %A Abraham,Charles %A Greaves,Colin J %+ College of Medicine and Health, University of Exeter, Smeall Building, Heavitree Road, Exeter, EX1 2LU, United Kingdom, 44 139272 ext 6440, s.b.vanbeurden@exeter.ac.uk %K weight loss %K mHealth %K digital behavior change %K obesity %K dual-process %D 2019 %7 30.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: ImpulsePal is a theory-driven (dual-process), evidence-informed, and person-centered smartphone app intervention designed to help people manage impulsive processes that prompt unhealthy eating to facilitate dietary change and weight loss. Objective: The aims of this study were to (1) assess the feasibility of trial procedures for evaluation of the ImpulsePal intervention, (2) estimate standard deviations of outcomes, and (3) assess usability of, and satisfaction with, ImpulsePal. Methods: We conducted an individually randomized parallel two-arm nonblinded feasibility trial. The eligibility criteria included being aged ≥16 years, having a body mass index of ≥25 kg/m2, and having access to an Android-based device. Weight was measured (as the proposed primary outcome for a full-scale trial) at baseline, 1 month, and 3 months of follow-up. Participants were randomized in a 2:1 allocation ratio to the ImpulsePal intervention or a waiting list control group. A nested action-research study allowed for data-driven refinement of the intervention across 2 cycles of feedback. Results: We screened 179 participants for eligibility, and 58 were randomized to the intervention group and 30 to the control group. Data were available for 74 (84%, 74/88) participants at 1 month and 67 (76%, 67/88) participants at 3 months. The intervention group (n=43) lost 1.03 kg (95% CI 0.33 to 1.74) more than controls (n=26) at 1 month and 1.01 kg (95% CI −0.45 to 2.47) more than controls (n=43 and n=24, respectively) at 3 months. Feedback suggested changes to intervention design were required to (1) improve receipt and understanding of instructions and (2) facilitate further engagement with the app and its strategies. Conclusions: The evaluation methods and delivery of the ImpulsePal app intervention are feasible, and the trial procedures, measures, and intervention are acceptable and satisfactory to the participants. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 14886370; http://www.isrctn.com/ISRCTN14886370 (Archived by WebCite at http://www.webcitation.org/76WcEpZ51) %M 31038464 %R 10.2196/11586 %U https://formative.jmir.org/2019/2/e11586/ %U https://doi.org/10.2196/11586 %U http://www.ncbi.nlm.nih.gov/pubmed/31038464 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12662 %T Smartphone-Based Meditation for Myeloproliferative Neoplasm Patients: Feasibility Study to Inform Future Trials %A Huberty,Jennifer %A Eckert,Ryan %A Larkey,Linda %A Kurka,Jonathan %A Rodríguez De Jesús,Sue A %A Yoo,Wonsuk %A Mesa,Ruben %+ College of Health Solutions, Arizona State University, 500 North 3rd St, Phoenix, AZ, 85004, United States, 1 402 301 1304, jhuberty@asu.edu %K mindfulness %K meditation %K smartphone %K mHealth %K cancer %K quality of life %D 2019 %7 29.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Myeloproliferative neoplasm (MPN) patients often report high symptom burden that persists despite the best available pharmacologic therapy. Meditation has gained popularity in recent decades as a way to manage cancer patient symptoms. Objective: The aim of this study was to examine the feasibility of 2 different consumer-based meditation smartphone apps in MPN patients and to examine the limited efficacy of smartphone-based meditation on symptoms compared with an educational control group. Methods: Patients (n=128) were recruited nationally through organizational partners and social media. Eligible and consented patients were enrolled into 1 of 4 groups, 2 of which received varying orders of 2 consumer-based apps (10% Happier and Calm) and 2 that received one of the apps alone for the second 4 weeks of the 8-week intervention after an educational control condition. Participants were asked to perform 10 min of meditation per day irrespective of the app and the order in which they received the apps. Feasibility outcomes were measured at weeks 5 and 9 with a Web-based survey. Feasibility outcomes were acceptability, demand, and limited efficacy for depression, anxiety, pain intensity, sleep disturbance, sexual function, quality of life, global health, and total symptom burden. Results: A total of 128 patients were enrolled across all 4 groups, with 73.4% (94/128) patients completing the intervention. Of the participants who completed the 10% Happier app, 61% (46/76) enjoyed it, 66% (50/76) were satisfied with the content, and 77% (59/76) would recommend to others. Of those who completed the Calm app, 83% (56/68) enjoyed it, 84% (57/68) were satisfied with the content, and 97% (66/68) would recommend to others. Of those who completed the educational control, 91% (56/61) read it, 87% (53/61) enjoyed it, and 71% (43/61) learned something. Participants who completed the 10% Happier app averaged 31 (SD 33) min/week; patients completing the Calm app averaged 71 (SD 74) min/week. 10% Happier app participants saw small effects on anxiety (P<.001 d=−0.43), depression (P=.02; d=−0.38), sleep disturbance (P=.01; d=−0.40), total symptom burden (P=.13; d=−0.27), and fatigue (P=.06; d=−0.30), and moderate effects on physical health (P<.001; d=0.52). Calm app participants saw small effects on anxiety (P=.29; d=−0.22), depression (P=.09; d=−0.29), sleep disturbance (P=.002; d=−0.47), physical health (P=.005; d=0.44), total symptom burden (P=.13; d=−0.27), and fatigue (P=.13; d=−0.27). Educational control participants (n=61) did not have effects on any patient-reported outcome except for a moderate effect on physical health (P<.001; d=0.77). Conclusions: Delivering meditation via the Calm app is feasible and scored higher in terms of feasibility when compared with the 10% Happier app. The Calm app will be used to implement a randomized controlled trial, testing the effects of meditation on symptom burden in MPNs. Trial Registration: ClinicalTrials.gov NCT03726944; https://clinicaltrials.gov/ct2/show/NCT03726944 (Archived by WebCite at http://www.webcitation.org/77MVdFJwM) %M 31033443 %R 10.2196/12662 %U http://formative.jmir.org/2019/2/e12662/ %U https://doi.org/10.2196/12662 %U http://www.ncbi.nlm.nih.gov/pubmed/31033443 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12982 %T An Adaptive Mobile Health System to Support Self-Management for Persons With Chronic Conditions and Disabilities: Usability and Feasibility Studies %A Setiawan,I Made Agus %A Zhou,Leming %A Alfikri,Zakiy %A Saptono,Andi %A Fairman,Andrea D %A Dicianno,Brad Edward %A Parmanto,Bambang %+ Department of Health Information Management, School of Health and Rehabilitation Sciences, University of Pittsburgh, 6025 Forbes Tower, Pittsburgh, PA, 15260, United States, 1 412 383 6649, parmanto@pitt.edu %K mHealth %K adaptive mHealth %K mobile apps %K telemedicine %K personalized medicine %K self-management %K self-care %K caregivers %K chronic disease %K persons with disabilities %D 2019 %7 25.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Persons with chronic conditions and disabilities (PwCCDs) are vulnerable to secondary complications. Many of these secondary complications are preventable with proactive self-management and proper support. To enhance PwCCDs' self-management skills and conveniently receive desired support, we have developed a mobile health (mHealth) system called iMHere. In 2 previous clinical trials, iMHere was successfully used to improve health outcomes of adult participants with spina bifida and spinal cord injury. To further expand use of iMHere among people with various types of disabilities and chronic diseases, the system needs to be more adaptive to address 3 unique challenges: 1) PwCCDs have very diverse needs with regards to self-management support, 2) PwCCDs’ self-management needs may change over time, and 3) it is a challenge to keep PwCCDs engaged and interested in long-term self-management. Objective: The aim of this study was to develop an adaptive mHealth system capable of supporting long-term self-management and adapting to the various needs and conditions of PwCCDs. Methods: A scalable and adaptive architecture was designed and implemented for the new version, iMHere 2.0. In this scalable architecture, a set of mobile app modules was created to provide various types of self-management support to PwCCDs with the ability to add more as needed. The adaptive architecture empowers PwCCDs with personally relevant app modules and allows clinicians to adapt these modules in response to PwCCDs’ evolving needs and conditions over time. Persuasive technologies, social support, and personalization features were integrated into iMHere 2.0 to engage and motivate PwCCDs and support long-term usage. Two initial studies were performed to evaluate the usability and feasibility of the iMHere 2.0 system. Results: The iMHere 2.0 system consists of cross-platform client and caregiver apps, a Web-based clinician portal, and a secure 2-way communication protocol for providing interactions among these 3 front-end components, all supported by a back-end server. The client and caregiver apps have 12 adaptive app modules to support various types of self-management tasks. The adaptive architecture makes it possible for PwCCDs to receive personalized app modules relevant to their conditions with or without support from various types of caregivers. The personalization and persuasive technologies in the architecture can be used to engage PwCCDs for long-term usage of the iMHere 2.0 system. Participants of the usability study were satisfied with the iMHere 2.0 client app. The feasibility evaluation revealed several practical issues to consider when implementing the system on a large scale. Conclusions: We developed an adaptive mHealth system as a novel method to support diverse needs in self-management for PwCCDs that can dynamically change over time. The usability of the client app is high, and it was feasible for PwCCDs to use in supporting personalized and evolving self-care needs. %M 31021324 %R 10.2196/12982 %U http://formative.jmir.org/2019/2/e12982/ %U https://doi.org/10.2196/12982 %U http://www.ncbi.nlm.nih.gov/pubmed/31021324 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11489 %T Measuring Free-Living Physical Activity With Three Commercially Available Activity Monitors for Telemonitoring Purposes: Validation Study %A Breteler,Martine JM %A Janssen,Joris H %A Spiering,Wilko %A Kalkman,Cor J %A van Solinge,Wouter W %A Dohmen,Daan AJ %+ Department of Anesthesiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht,, Netherlands, 31 647396841, m.j.m.breteler@umcutrecht.nl %K activity trackers %K telemedicine %K exercise %D 2019 %7 24.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Remote monitoring of physical activity in patients with chronic conditions could be useful to offer care professionals real-time assessment of their patient’s daily activity pattern to adjust appropriate treatment. However, the validity of commercially available activity trackers that can be used for telemonitoring purposes is limited. Objective: The purpose of this study was to test usability and determine the validity of 3 consumer-level activity trackers as a measure of free-living activity. Methods: A usability evaluation (study 1) and validation study (study 2) were conducted. In study 1, 10 individuals wore one activity tracker for a period of 30 days and filled in a questionnaire on ease of use and wearability. In study 2, we validated three selected activity trackers (Apple Watch, Misfit Shine, and iHealth Edge) and a fourth pedometer (Yamax Digiwalker) against the reference standard (Actigraph GT3X) in 30 healthy participants for 72 hours. Outcome measures were 95% limits of agreement (LoA) and bias (Bland-Altman analysis). Furthermore, median absolute differences (MAD) were calculated. Correction for bias was estimated and validated using leave-one-out cross validation. Results: Usability evaluation of study 1 showed that iHealth Edge and Apple Watch were more comfortable to wear as compared with the Misfit Flash. Therefore, the Misfit Flash was replaced by Misfit Shine in study 2. During study 2, the total number of steps of the reference standard was 21,527 (interquartile range, IQR 17,475-24,809). Bias and LoA for number of steps from the Apple Watch and iHealth Edge were 968 (IQR −5478 to 7414) and 2021 (IQR −4994 to 9036) steps. For Misfit Shine and Yamax Digiwalker, bias was −1874 and 2004, both with wide LoA of (13,869 to 10,121) and (−10,932 to 14,940) steps, respectively. The Apple Watch noted the smallest MAD of 7.7% with the Actigraph, whereas the Yamax Digiwalker noted the highest MAD (20.3%). After leave-one-out cross validation, accuracy estimates of MAD of the iHealth Edge and Misfit Shine were within acceptable limits with 10.7% and 11.3%, respectively. Conclusions: Overall, the Apple Watch and iHealth Edge were positively evaluated after wearing. Validity varied widely between devices, with the Apple Watch being the most accurate and Yamax Digiwalker the least accurate for step count in free-living conditions. The iHealth Edge underestimates number of steps but can be considered reliable for activity monitoring after correction for bias. Misfit Shine overestimated number of steps and cannot be considered suitable for step count because of the low agreement. Future studies should focus on the added value of remotely monitoring activity patterns over time in chronic patients. %M 31017587 %R 10.2196/11489 %U http://formative.jmir.org/2019/2/e11489/ %U https://doi.org/10.2196/11489 %U http://www.ncbi.nlm.nih.gov/pubmed/31017587 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12028 %T iCanCope PostOp: User-Centered Design of a Smartphone-Based App for Self-Management of Postoperative Pain in Children and Adolescents %A Birnie,Kathryn A %A Campbell,Fiona %A Nguyen,Cynthia %A Lalloo,Chitra %A Tsimicalis,Argerie %A Matava,Clyde %A Cafazzo,Joseph %A Stinson,Jennifer %+ Child Health Evaluative Sciences, The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, Toronto, ON, M5G 0A4, Canada, 1 416 813 7654, kathryn.birnie@sickkids.ca %K postoperative pain %K smartphone %K mobile applications %K mHealth %K pain management %K self-management %K adolescent %D 2019 %7 22.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Moderate to severe postoperative pain in children is common. Increased pediatric day surgeries have shifted postoperative pain management predominantly to the home setting. Mobile health technology has the potential to overcome barriers to pain care by improving access to self-management resources. However, pain apps generally lack scientific evidence and are highly underutilized due to lack of involvement of end users in their development. Thus, an evidence-based pain self-management smartphone app that incorporates the needs and perspective of children and adolescents (end users) has potential to improve postoperative pain management. Objective: This paper aimed to describe how the principles of user-centered design were applied to the development of iCanCope PostOp, a smartphone-based pain self-management app for children and adolescents after surgery. Specifically, it presents 2 completed phases of the user-centered design process (concept generation and ideation) for the iCanCope PostOp app. Methods: Phase 1 was a multisite needs assessment from the perspective of 19 children and adolescents who had undergone various day surgeries, 19 parents, and 32 multidisciplinary health care providers. Children, adolescents, and parents completed individual semistructured interviews, and health care providers participated in focus groups. Data were summarized using qualitative content analysis. Phase 2 developed a pain care algorithm for the app using Delphi surveys and a 2-day in-person design workshop with 11 multidisciplinary pediatric postoperative pain experts and 2 people with lived experience with postoperative pain. Results: Phase 1 identified self-management challenges to postoperative pain management and recovery; limited available resources and reliance on medications as a predominant postoperative pain management strategy; and shared responsibility of postoperative pain care by children and adolescents, parents, and health care providers. Key app functions of tracking pain, pain self-management strategies, and goal setting were identified as priorities. Phase 2 led to the successful and efficient generation of a complete preliminary pain care algorithm for the iCanCope PostOp app, including clinically relevant inputs for feasible assessment and reassessment of pain and function (rest or sleep, movement or play, and mood or worry), as well as a catalog of pain management advice to be pushed to end users (psychological, physical, pharmacological, and education). Conclusions: The concept ideation and generation phases of the user-centered design approach were successfully completed for the iCanCope PostOp app. Next steps will include design finalization, app development (iOS or Android), evaluation through a randomized controlled trial, and subsequent implementation of the iCanCope PostOp app in clinical care. %M 31008704 %R 10.2196/12028 %U http://formative.jmir.org/2019/2/e12028/ %U https://doi.org/10.2196/12028 %U http://www.ncbi.nlm.nih.gov/pubmed/31008704 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e10880 %T AO Patient Outcomes Center: Design, Implementation, and Evaluation of a Software Application for the Collection of Patient-Reported Outcome Measures in Orthopedic Outpatient Clinics %A Rothrock,Nan E %A Bass,Michael %A Blumenthal,Andrea %A Gershon,Richard C %A Hanson,Beate %A Joeris,Alexander %A Kaat,Aaron %A Morrison,Suzanne %A O'Toole,Robert V %A Patel,Shalini %A Stover,Michael %A Weaver,Michael J %A White,Raymond %A Varela Diaz,Maria %A Vrahas,Mark S %+ Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 625 North Michigan Avenue, Suite 2700, Chicago, IL, 60611, United States, 1 312 503 3514, n-rothrock@northwestern.edu %K orthopedics %K patient reported outcome measures %K tablet computers %D 2019 %7 12.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient-reported outcomes are increasingly utilized in routine orthopedic clinical care. Computer adaptive tests (CATs) from the Patient-Reported Outcomes Measurement Information System (PROMIS) offer a brief and precise assessment that is well suited for collection within busy clinical environments. However, software apps that support the administration and scoring of CATs, provide immediate access to patient-reported outcome (PRO) scores, and minimize clinician burden are not widely available. Objective: Our objective was to design, implement, and test the feasibility and usability of a Web-based system for collecting CATs in orthopedic clinics. Methods: AO Patient Outcomes Center (AOPOC) was subjected to 2 rounds of testing. Alpha testing was conducted in 3 orthopedic clinics to evaluate ease of use and feasibility of integration in clinics. Patients completed an assessment of PROMIS CATs and a usability survey. Clinicians participated in a brief semistructured interview. Beta-phase testing evaluated system performance through load testing and usability of the updated version of AOPOC. In both rounds of testing, user satisfaction, bugs, change requests, and performance of PROMIS CATs were captured. Results: Patient feedback supported the ease of use in completing an assessment in AOPOC. Across both phases of testing, clinicians rated AOPOC as easy to use but noted difficulties in integrating a Web-based software application within their clinics. PROMIS CATs performed well; the default assessment of 2 CATs was completed quickly (mean 9.5 items) with a satisfactory range of measurement. Conclusion: AOPOC was demonstrated to be an easy-to-learn and easy-to-use software application for patients and clinicians that can be integrated into orthopedic clinical care. The workflow disruption in integrating any type of PRO collection must be addressed if patients’ voices are to be better integrated in clinical care. %M 30977735 %R 10.2196/10880 %U https://formative.jmir.org/2019/2/e10880/ %U https://doi.org/10.2196/10880 %U http://www.ncbi.nlm.nih.gov/pubmed/30977735 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e10990 %T Development of a Smartphone App for Informal Carers of People With Cancer: Processes and Learnings %A Heynsbergh,Natalie %A Heckel,Leila %A Botti,Mari %A O,Seung Chul %A Livingston,Patricia M %+ School of Nursing and Midwifery, Faculty of Health, Deakin University, Geelong,, Australia, 61 392446333, n.heynsbergh@deakin.edu.au %K cancer %K carer %K smartphone %K mobile applications %K technology %D 2019 %7 11.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: There are few support systems available to informal carers who provide care to cancer patients. Smartphone apps have the capacity to reach large audiences and can provide information and support at a time convenient to carers. Objective: The aim of this study was to design a smartphone app prototype for carers of adults with cancer. Methods: A multiple-method design was used to develop a smartphone app. Current and past carers of people with any type of cancer were recruited from a public hospital, a private hospital, and a carer organization, who participated in either a focus group or phone interview. Carers answered questions about items to include in an app to address supportive care needs identified. Using carers’ feedback, a smartphone app was designed and tested. Beta testing was conducted using a convenience sample of participants who completed scenarios to inform the app’s design, functionality, and usability. Scenarios were timed and marked as complete or incomplete. Participants completed a questionnaire about the usability of the app. Beta testing occurred in 2 stages—a paper-based version of the app and an app-based test using the participants’ preferred device. Alpha testing was completed internally to ensure the functionality of the app. Data were collected between May 2016 and August 2017. Results: A total of 33 carers participated in phone interviews and 12 in focus groups; their average age was 55 (SD 14) years, and 60% (27/45) were female. The majority of carers (76%, 25/33) had a positive attitude toward using smartphone apps. Carers noted that smartphone technology might improve their ability to seek information and support in managing their own health as well as the care needs of the person with cancer. Carers requested a variety of information and resources to be included in the app. Paper-based testing included the following: participants (N=10) were aged above 30 years (30%, 3/10), 30 to 49 years (30%, 3/10), and 50 years or above (40%, 4/10), and 60% (6/10) were male. Participants found the app user-friendly and pleasing in appearance. App-based testing included the following: participants (N=10) were aged above 30 years (20%, 2/10), 30 to 49 years (30%, 3/10), and 50 years or above (50%, 5/10), and 50% (5/10) were male. Participants reported the app to be user-friendly and easy to navigate. The majority (60%, 6/10) of participants were unable to create a shortcut icon to add the app to the home screen of their phone. Conclusions: Carers highlighted the needed information and support to assist them during the caring period; they also reported having a positive attitude toward smartphone apps. The Carer Guide App is currently undergoing a pilot study to further test usability among carers of people with 1 cancer type. %M 30973346 %R 10.2196/10990 %U http://formative.jmir.org/2019/2/e10990/ %U https://doi.org/10.2196/10990 %U http://www.ncbi.nlm.nih.gov/pubmed/30973346 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e9910 %T A Pilot Randomized Controlled Trial of a Digital Intervention Aimed at Improving Food Purchasing Behavior: The Front-of-Pack Food Labels Impact on Consumer Choice Study %A Harrington,Richard A %A Scarborough,Peter %A Hodgkins,Charo %A Raats,Monique M %A Cowburn,Gill %A Dean,Moira %A Doherty,Aiden %A Foster,Charlie %A Juszczak,Edmund %A Ni Mhurchu,Cliona %A Winstone,Naomi %A Shepherd,Richard %A Timotijevic,Lada %A Rayner,Mike %+ Centre on Population Approaches for Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Headington, Oxford, OX3 7LF, United Kingdom, 44 1865289248, peter.scarborough@dph.ox.ac.uk %K diet %K randomized controlled trial %D 2019 %7 08.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Most food in the United Kingdom is purchased in supermarkets, and many of these purchases are routinely tracked through supermarket loyalty card data. Using such data may be an effective way to develop remote public health interventions and to measure objectively their effectiveness at changing food purchasing behavior. Objective: The Front-of-pack food Labels: Impact on Consumer Choice (FLICC) study is a pilot randomized controlled trial of a digital behavior change intervention. This pilot trial aimed to collect data on recruitment and retention rates and to provide estimates of effect sizes for the primary outcome (healthiness of ready meals and pizzas purchased) to inform a larger trial. Methods: The intervention consisted of a website where participants could access tailored feedback on previous purchases of ready meals and pizzas, set goals for behavior change, and model and practice the recommended healthy shopping behavior using traffic light labels. The control consisted of Web-based information on traffic light labeling. Participants were recruited via email from a list of loyalty card holders held by the participating supermarket. All food and drink purchases for the participants for the 6 months before recruitment, during the 6-week intervention period, and during a 12-week washout period were transferred to the research team by the participating supermarket. Healthiness of ready meals and pizzas was measured using a predeveloped scale based solely on the traffic light colors on the foods. Questionnaires were completed at recruitment, end of the intervention, and end of washout to estimate the effect of the intervention on variables that mediate behavior change (eg, belief and intention formation). Results: We recruited 496 participants from an initial email to 50,000 people. Only 3 people withdrew from the study, and purchase data were received for all other participants. A total of 208 participants completed all 3 questionnaires. There was no difference in the healthiness of purchased ready meals and pizzas between the intervention and control arms either during the intervention period (P=.32) or at washout (P=.59). Conclusions: Although the FLICC study did not find evidence of an impact of the intervention on food purchasing behavior, the unique methods used in this pilot trial are informative for future studies that plan to use supermarket loyalty card data in collaboration with supermarket partners. The experience of the trial showcases the possibilities and challenges associated with the use of loyalty card data in public health research. Trial Registration: ISRCTN Registry ISRCTN19316955; http://www.isrctn.com/ISRCTN19316955 (Archived by WebCite at http://www.webcitation.org/76IVZ9WjK) International Registered Report Identifier (IRRID): RR2-10.1186/s40814-015-0015-1 %M 30958277 %R 10.2196/formative.9910 %U http://formative.jmir.org/2019/2/e9910/ %U https://doi.org/10.2196/formative.9910 %U http://www.ncbi.nlm.nih.gov/pubmed/30958277 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11342 %T Developing a Data Dashboard Framework for Population Health Surveillance: Widening Access to Clinical Trial Findings %A Concannon,David %A Herbst,Kobus %A Manley,Ed %+ Centre for Advanced Spatial Analysis, University College London, Gower Street, London,, United Kingdom, 44 02031083884, ed.manley@ucl.ac.uk %K data visualization %K data dashboards %K health and demographic surveillance %K sub-Saharan Africa %K treatment as prevention %K clinical trials %K demographics %K real-time %K data literacy %D 2019 %7 04.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Population surveillance sites generate many datasets relevant to disease surveillance. However, there is a risk that these data are underutilized because of the volumes of data gathered and the lack of means to quickly disseminate analysis. Data visualization offers a means to quickly disseminate, understand, and interpret datasets, facilitating evidence-driven decision making through increased access to information. Objectives: This paper describes the development and evaluation of a framework for data dashboard design, to visualize datasets produced at a demographic health surveillance site. The aim of this research was to produce a comprehensive, reusable, and scalable dashboard design framework to fit the unique requirements of the context. Methods: The framework was developed and implemented at a demographic surveillance platform at the Africa Health Research Institute, in KwaZulu-Natal, South Africa. This context represents an exemplar implementation for the use of data dashboards within a population health-monitoring setting. Before the full launch, an evaluation study was undertaken to assess the effectiveness of the dashboard framework as a data communication and decision-making tool. The evaluation included a quantitative task evaluation to assess usability and a qualitative questionnaire exploring the attitudes to the use of dashboards. Results: The evaluation participants were drawn from a diverse group of users working at the site (n=20), comprising of community members, nurses, scientific and operational staff. Evaluation demonstrated high usability for the dashboard across user groups, with scientific and operational staff having minimal issues in completing tasks. There were notable differences in the efficiency of task completion among user groups, indicating varying familiarity with data visualization. The majority of users felt that the dashboards provided a clear understanding of the datasets presented and had a positive attitude to their increased use. Conclusions: Overall, this exploratory study indicates the viability of the data dashboard framework in communicating data trends within population surveillance setting. The usability differences among the user groups discovered during the evaluation demonstrate the need for the user-led design of dashboards in this context, addressing heterogeneous computer and visualization literacy present among the diverse potential users present in such settings. The questionnaire highlighted the enthusiasm for increased access to datasets from all stakeholders highlighting the potential of dashboards in this context. %M 30946016 %R 10.2196/11342 %U https://formative.jmir.org/2019/2/e11342/ %U https://doi.org/10.2196/11342 %U http://www.ncbi.nlm.nih.gov/pubmed/30946016 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11397 %T Using Text Messaging, Social Media, and Interviews to Understand What Pregnant Youth Think About Weight Gain During Pregnancy %A DeJonckheere,Melissa %A Nichols,Lauren P %A Vydiswaran,VG Vinod %A Zhao,Xinyan %A Collins-Thompson,Kevyn %A Resnicow,Kenneth %A Chang,Tammy %+ Department of Family Medicine, University of Michigan, 1018 Fuller St, Ann Arbor, MI, 48104, United States, 1 (734) 998 7120, mjdejonckheere@gmail.com %K methods %K adolescents %K weight gain %K pregnancy %K text messaging %K social media %K natural language processing %D 2019 %7 01.04.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: The majority of pregnant youth gain more weight than recommended by the National Academy of Medicine guidelines. Excess weight gain during pregnancy increases the risk of dangerous complications during delivery, including operative delivery and stillbirth, and contributes to the risk of long-term obesity in both mother and child. Little is known regarding youth’s perceptions of and knowledge about weight gain during pregnancy. Objective: The aim of this study was to describe the feasibility and acceptability of 3 novel data collection and analysis strategies for use with youth (social media posts, text message surveys, and semistructured interviews) to explore their experiences during pregnancy. The mixed-methods analysis included natural language processing and thematic analysis. Methods: To demonstrate the feasibility and acceptability of this novel approach, we used descriptive statistics and thematic qualitative analysis to characterize participation and engagement in the study. Results: Recruitment of 54 pregnant women aged between 16 and 24 years occurred from April 2016 to September 2016. All participants completed at least 1 phase of the study. Semistructured interviews had the highest rate of completion, yet all 3 strategies were feasible and acceptable to pregnant youth. Conclusions: This study has described a novel youth-centered strategy of triangulating 3 sources of mixed-methods data to gain a deeper understanding of a health behavior phenomenon among an at-risk population of youth. %M 30932869 %R 10.2196/11397 %U https://formative.jmir.org/2019/2/e11397/ %U https://doi.org/10.2196/11397 %U http://www.ncbi.nlm.nih.gov/pubmed/30932869 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11600 %T Cultural Adaptation of a Scalable World Health Organization E-Mental Health Program for Overseas Filipino Workers %A Garabiles,Melissa R %A Harper Shehadeh,Melissa %A Hall,Brian J %+ Global and Community Mental Health Research Group, The University of Macau, E21-3040, Avenida da Universidade, Macau, 99908, China, 86 62899837, brianhall@um.edu.mo %K cultural adaptation %K migrant workers %K e-mental health %K overseas Filipino workers %D 2019 %7 29.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic mental (e-mental) health interventions can address mental health needs of different populations. Cultural adaptation of these interventions is crucial to establish a better fit with the cultural group and to achieve better treatment outcomes. Objective: This study aimed to describe the cultural adaptation of the World Health Organization’s e-mental health program Step-by-Step for overseas Filipino workers. We used a framework which posits that cultural adaptation should enhance (1) relevance, wherein the cultural group can relate with the content; (2) acceptability, where the cultural group will not find any element offensive; (3) comprehensibility, where the program is understandable; and (4) completeness, wherein the adapted version covers the same concepts and constructs as the original program. We aimed to have English and Filipino and male and female versions. Methods: Overall, 3 experienced Filipino psychologists provided their perspectives on the program and how it might be adapted for overseas Filipino workers. We then adapted the program and obtained feedback from 28 overseas Filipino workers from diverse industries through focus group discussions. We conducted 7 and 9 focus group discussions with male and female participants, respectively. Per discussion, cognitive interviewing was used to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Participant feedback guided iterative program adaptations, which were again shown to participants for validation and improvement. Results: Several issues were raised by participants about the generic version of Step-by-Step. There were elements deemed irrelevant, like unfitting characters, lack of Filipino values, and unsuitable problems and activities. There were unacceptable components that were stigmatizing, political, inappropriate to context or subgroups, and too feminine for male users. Some elements were incomprehensible, unclear, or complicated. To address these issues, we made key adaptations. To enhance relevance, we adapted the narrative to match the experiences of overseas Filipino workers, incorporated Filipino values, and illustrated familiar problems and activities. To increase acceptability, our main characters were changed to wise elders rather than health professionals (reducing mental health and help-seeking stigma), political or unacceptable content was removed, and the program was made suitable for overseas Filipino workers from different sectors. To increase comprehension, we used English and Filipino languages, simplified the text to ease interpretation of abstract terms, and ensured that text and illustrations matched. We also used Taglish (ie, merged English and Filipino) when participants deemed pure Filipino translations sounded odd or incomprehensible. Finally, we retained the core elements and concepts included in the original Step-by-Step program to maintain completeness. Conclusions: This study showed the utility of a 4-point framework that focuses on acceptance, relevance, comprehensibility, and completeness in cultural adaptation. Moreover, we achieved a culturally appropriate adapted version of the Step-by-Step program for overseas Filipino workers. We discuss lessons learned in the process to guide future cultural adaptation projects of e-mental health interventions. %M 30924784 %R 10.2196/11600 %U https://formative.jmir.org/2019/1/e11600/ %U https://doi.org/10.2196/11600 %U http://www.ncbi.nlm.nih.gov/pubmed/30924784 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11300 %T Challenges in the Development of e-Quit worRx: An iPad App for Smoking Cessation Counseling and Shared Decision Making in Primary Care %A Doarn,Charles R %A Vonder Meulen,Mary Beth %A Pallerla,Harini %A Acquavita,Shauna P %A Regan,Saundra %A Elder,Nancy %A Tubb,Matthew R %+ Department of Family and Community Medicine, University of Cincinnati, 231 Albert Sabin Way, ML0582, Cincinnati, OH, 45267, United States, 1 5135586148, charles.doarn@uc.edu %K mobile health %K smoking cessation %K primary care %K decision aid %D 2019 %7 29.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is the leading preventable cause of morbidity and mortality in the United States, killing more than 450,000 Americans. Primary care physicians (PCPs) have a unique opportunity to discuss smoking cessation evidence in a way that enhances patient-initiated change and quit attempts. Patients today are better equipped with technology such as mobile devices than ever before. Objective: The aim of this study was to evaluate the challenges in developing a tablet-based, evidence-based smoking cessation app to optimize interaction for shared decision making between PCPs and their patients who smoke. Methods: A group of interprofessional experts developed content and a graphical user interface for the decision aid and reviewed these with several focus groups to determine acceptability and usability in a small population. Results: Using a storyboard methodology and subject matter experts, a mobile app, e-Quit worRx, was developed through an iterative process. This iterative process helped finalize the content and ergonomics of the app and provided valuable feedback from both patients and provider teams. Once the app was made available, other technical and programmatic challenges arose. Conclusions: Subject matter experts, although generally amenable to one another’s disciplines, are often challenged with effective interactions, including language, scope, clinical understanding, technology awareness, and expectations. The successful development of this app and its evaluation in a clinical setting highlighted those challenges and reinforced the need for effective communications and team building. %M 30924783 %R 10.2196/11300 %U https://formative.jmir.org/2019/1/e11300/ %U https://doi.org/10.2196/11300 %U http://www.ncbi.nlm.nih.gov/pubmed/30924783 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11374 %T Pregnant Users’ Perceptions of the Birth Plan Interface in the “My Prenatal Care” App: Observational Validation Study %A Moraes Carrilho,Juliana %A Oliveira,Isaias José Ramos %A Santos,Dimitri %A Osanan,Gabriel Costa %A Cruz-Correia,Ricardo João %A Reis,Zilma Silveira Nogueira %+ Informatics Center in Health, Universidade Federal de Minas Gerais, Faculty of Medicine, Av Professor Alfredo Balena, 190, Funcionários, Belo Horizonte, 30140070, Brazil, 55 31985177473, zilma.medicina@gmail.com %K birth plan %K perinatal care %K usability, mobile health %K mobile app %K pregnancy %K prenatal care %K mobile phone %D 2019 %7 28.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Birth plans are meant to be a declaration of the expectations and preferences of pregnant woman regarding childbirth. The My Prenatal Care app engages pregnant women in an educational intervention for a healthy pregnancy. We hypothesized that users’ positive perception of an in-app birth plan is a relevant step for establishing direct communication between pregnant women and the health care team, based on an online report available on the app. Objective: This study aimed to evaluate pregnant women’s perception about the communicability of birth-plan preparation using a mobile app. Methods: This was an observational, exploratory, descriptive study. The methodology was user centered, and both qualitative and quantitative approaches were employed. The tools of the communicability evaluation method were applied. Overall, 11 pregnant women evaluated their experience of using a birth-plan prototype interface. The evaluation was performed in a controlled environment, with authorized video recording. There were 8 task-oriented interactions proposed to evaluate interface communicability with users when using the Birth Plan menu. For evaluating perceptions and experiences, a survey with structured and open-ended questions in addition to the free expression of participants was conducted. The primary outcomes assessed were interface communicability and user’s perception of the Birth Plan prototype interface in the My Prenatal Care mobile app. Secondarily, we involved users in the prototyping phase of the interface to identify bottlenecks for making improvements in the app. Results: Regarding users’ performance in accomplishing previously prepared tasks, we found that 10 of 11 (91%) women were capable of completing at least 6 of 8 (75%) tasks. A positive relationship was found between the number of communicability problems and the success of completing the tasks. An analysis of the records revealed three communicability breakdowns related to the data entry, save, and scrollbar functions. The participants freely expressed suggestions for improvements such as for the save function and the process of sharing the birth-plan form upon completion. Conclusions: Users had a positive perception of the Birth Plan menu of the My Prenatal Care app. This user-centered validation enabled the identification of solutions for problems, resulting in improvements in the app. %M 30920372 %R 10.2196/11374 %U http://formative.jmir.org/2019/1/e11374/ %U https://doi.org/10.2196/11374 %U http://www.ncbi.nlm.nih.gov/pubmed/30920372 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e10731 %T The Development of VegEze: Smartphone App to Increase Vegetable Consumption in Australian Adults %A Hendrie,Gilly A %A James-Martin,Genevieve %A Williams,Gemma %A Brindal,Emily %A Whyte,Ben %A Crook,Anna %+ Health & Biosecurity, Commonwealth Scientific and Industrial Research Organisation, PO Box 10041, Adelaide, 5000, Australia, 61 88305 ext 0662, gilly.hendrie@csiro.au %K mHealth %K mobile applications %K vegetables %K adult %D 2019 %7 27.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor-quality dietary patterns are often characterized by inadequate consumption of fruits and vegetables. Changing dietary behavior is difficult, and although it is often clear what needs to change, how to enact change is more difficult. Smartphones have characteristics that may support the complexity of changing dietary behavior. Objective: This paper describes the iterative process of developing a theory-based smartphone app called VegEze that aimed to increase vegetable consumption. Methods: To upscale, reach target users, and create a user-friendly end product, a collaborative research-industry partnership was formed to build the app over a 20-week period. The Integrate, Design, Assess, and Share framework was used as a scientific basis to guide the development. The behavior change wheel was also used as a theoretical grounding in combination with other theory-based strategies, such as self-monitoring, social comparison, and gamification—which have all been shown to be successful in dietary change or digital health interventions. We conducted 1 consumer survey (N=1068), 1 usability testing session (N=11), and a pilot effectiveness and usability trial (N=283) to inform the design of the app. Results: The target behavior for the app was defined as having 3 different types of vegetables at dinner. The perceived achievability of this target behavior was high; 93% of respondents (993/1068 users) felt they were likely or very likely to be able to regularly achieve the behavior. App features that users wanted included the following: recipes and meal ideas (876/1068, 82% of users), functionality to track their intake (662/1068, 62%), and information on how to prepare vegetables (545/1068, 51%). On the basis of importance of self-monitoring as a behavior change technique (BCT) and its rating by users, the vegetable tracker was a core feature of the app and was designed to be quick and simple to use. Daily feedback messages for logging intake and communicating progress were designed to be engaging and fun, using friendly, positive language and emoji icons. Daily and weekly feedback on vegetable consumption was designed to be simple, informative, and reinforce monitoring. A creative team was engaged to assist in the branding of the app to ensure it had an identity that reflected the fun and simple nature of the underlying behavior. The app included 16 BCTs, most of which were from the goals and planning subsection of the BCT taxonomy. Conclusions: Combining a theoretical framework with an industry perspective and input resulted in an app that was developed in a timely manner while retaining its evidence-base. VegEze is an iOS app currently available in the App Store, and the overall impact of the VegEze app will be evaluated in an uncontrolled, quantitative study. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000481279; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12618000481279 (Archived by WebCite: at http://www.webcitation.org/769oG9EaA) %M 30916653 %R 10.2196/10731 %U http://formative.jmir.org/2019/1/e10731/ %U https://doi.org/10.2196/10731 %U http://www.ncbi.nlm.nih.gov/pubmed/30916653 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 1 %P e11852 %T High-Fidelity Prototyping for Mobile Electronic Data Collection Forms Through Design and User Evaluation %A Mugisha,Alice %A Babic,Ankica %A Wakholi,Peter %A Tylleskär,Thorkild %+ Center for International Health, Department of Global Public Health and Primary Care, University of Bergen, Årstadveien 21 Overlege Danielssens building, Bergen, 5020, Norway, 47 99884851, mugishaalice@gmail.com %K high-fidelity prototype %K group user testing %K mobile electronic data collection forms %K usability evaluation %D 2019 %7 22.03.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mobile data collection systems are often difficult to use for nontechnical or novice users. This can be attributed to the fact that developers of such tools do not adequately involve end users in the design and development of product features and functions, which often creates interaction challenges. Objective: The main objective of this study was to assess the guidelines for form design using high-fidelity prototypes developed based on end-user preferences. We also sought to investigate the association between the results from the System Usability Scale (SUS) and those from the Study Tailored Evaluation Questionnaire (STEQ) after the evaluation. In addition, we sought to recommend some practical guidelines for the implementation of the group testing approach particularly in low-resource settings during mobile form design. Methods: We developed a Web-based high-fidelity prototype using Axure RP 8. A total of 30 research assistants (RAs) evaluated this prototype in March 2018 by completing the given tasks during 1 common session. An STEQ comprising 13 affirmative statements and the commonly used and validated SUS were administered to evaluate the usability and user experience after interaction with the prototype. The STEQ evaluation was summarized using frequencies in an Excel sheet while the SUS scores were calculated based on whether the statement was positive (user selection minus 1) or negative (5 minus user selection). These were summed up and the score contributions multiplied by 2.5 to give the overall form usability from each participant. Results: Of the RAs, 80% (24/30) appreciated the form progress indication, found the form navigation easy, and were satisfied with the error messages. The results gave a SUS average score of 70.4 (SD 11.7), which is above the recommended average SUS score of 68, meaning that the usability of the prototype was above average. The scores from the STEQ, on the other hand, indicated a 70% (21/30) level of agreement with the affirmative evaluation statements. The results from the 2 instruments indicated a fair level of user satisfaction and a strong positive association as shown by the Pearson correlation value of .623 (P<.01). Conclusions: A high-fidelity prototype was used to give the users experience with a product they would likely use in their work. Group testing was done because of scarcity of resources such as costs and time involved especially in low-income countries. If embraced, this approach could help assess user needs of the diverse user groups. With proper preparation and the right infrastructure at an affordable cost, usability testing could lead to the development of highly usable forms. The study thus makes recommendations on the practical guidelines for the implementation of the group testing approach particularly in low-resource settings during mobile form design. %M 30900995 %R 10.2196/11852 %U http://humanfactors.jmir.org/2019/1/e11852/ %U https://doi.org/10.2196/11852 %U http://www.ncbi.nlm.nih.gov/pubmed/30900995 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11578 %T Development of PositiveLinks: A Mobile Phone App to Promote Linkage and Retention in Care for People With HIV %A Laurence,Colleen %A Wispelwey,Erin %A Flickinger,Tabor E %A Grabowski,Marika %A Waldman,Ava Lena %A Plews-Ogan,Erin %A Debolt,Claire %A Reynolds,George %A Cohn,Wendy %A Ingersoll,Karen %A Dillingham,Rebecca %+ Department of Medicine, University of Virginia School of Medicine, PO Box 801379, Charlottesville, VA, 22908, United States, 1 434 982 0103, Rd8v@hscmail.mcc.virginia.edu %K mHealth %K HIV %K treatment adherence and compliance %K retention in care %D 2019 %7 20.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Linkage to and retention in HIV care are challenging, especially in the Southeastern United States. The rise in mobile phone app use and the potential for an app to deliver just in time messaging provides a new opportunity to improve linkage and retention among people living with HIV (PLWH). Objective: This study aimed to develop an app to engage, link, and retain people in care. We evaluated the acceptability, feasibility, and impact of the app among users. Methods: App development was informed by principles of chronic disease self-management and formative interviews with PLWH. Once developed, the app was distributed among participants, and usability feedback was incorporated in subsequent iterations. We interviewed app users after 3 weeks to identify usability issues, need for training on the phone or app, and to assess acceptability. We tracked and analyzed usage of app features for the cohort over 2 years. Results: A total of 77 participants used the app during the pilot study. The query response rate for the first 2 years was 47.7%. Query response declined at a rate of 0.67% per month. The community message board was the most popular feature, and 77.9% (60/77) of users posted on the board at least once during the 2 years. Conclusions: The PositiveLinks app was feasible and acceptable among nonurban PLWH. High participation on the community message board suggests that social support from peers is important for people recently diagnosed with or returning to care for HIV. %M 30892269 %R 10.2196/11578 %U http://formative.jmir.org/2019/1/e11578/ %U https://doi.org/10.2196/11578 %U http://www.ncbi.nlm.nih.gov/pubmed/30892269 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e12489 %T An mHealth Assistive System “MyLung” to Empower Patients with Chronic Obstructive Pulmonary Disease: Design Science Research %A Alharbey,Riad %A Chatterjee,Samir %+ Information Systems and Technology, College of Computer Science and Engineering, University of Jeddah, Asfan 21959, Jeddah,, Saudi Arabia, 966 545593498, ralharbi@uj.edu.sa %K assistive technology %K patient empowerment %K chronic obstructive pulmonary disease %K design science research %D 2019 %7 19.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) comprises a group of progressive diseases that deteriorate lung functions. When patients cannot breathe, nothing else in their lives matter. Breathlessness has negative implications on patients’ lives, which leads to physical and psychological limitations. Moreover, the lack of relevant and updated information about the causes and consequences of the disease can exacerbate the problems of health literacy, information accessibility, and medical adherence. Objective: The objective of this study is to design an innovative mobile health (mHealth) app system called “MyLung” that provides complete solutions in order to increase self-awareness and promote better self-care management. This system, an information technology artifact, includes three novel integrative modules: education, risk reduction, and monitoring. Methods: The utility and effectiveness of the assistive mobile-based technology were evaluated using a mixed-methods approach. The study combined quantitative and qualitative research methods to thoroughly understand how the assistive mobile-based technology can influence patients’ behavioral intention to change their lifestyle. Thirty patients were categorized into two groups (intervention group and control group). Results: The results from the quantitative analysis led to four follow-up interviews in the qualitative study. The results of the quantitative study provided significant evidence to show that the design of MyLung leads to a change in the awareness level, self-efficacy, and behavioral intention for patients with COPD. The t tests revealed a significant difference before and after using the mobile-based app with regard to the awareness level (mean 3.28 vs 4.56; t10=6.062; P<.001), self-efficacy (mean 3.11 vs 5.56; t10=2.96; P=.01), and behavioral intention (mean 2.91 vs 4.55; t10=3.212; P=.009). Independent sample t tests revealed significant differences between the intervention group and the control group in terms of the awareness level (mean 4.56 vs 3.31; t19=4.80; P<.001) and self-efficacy (mean 5.56 vs 3.66; t19=2.8; P<.01). Integration of findings from quantitative and qualitative studies reveled the impact of the design in a comprehensive manner. These inferences are referred to as “meta-inferences” in this study. Conclusions: We designed an innovative assistive mobile-based technology to empower patients with COPD, which helped increase awareness and engage patients in self-care management activities. The assistive technology aims to inform patients about the risk factors of COPD and to improve access to relevant information. Meta-inferences that emerge from the research outputs contribute to research into chronic management information systems by helping us gain a more complete understanding of the potential impacts of this proposed mobile-based design on patients with chronic disease. %M 30888329 %R 10.2196/12489 %U http://formative.jmir.org/2019/1/e12489/ %U https://doi.org/10.2196/12489 %U http://www.ncbi.nlm.nih.gov/pubmed/30888329 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11689 %T A Mobile App to Promote Adapted Exercise and Social Networking for People With Physical Disabilities: Usability Study %A Lai,Byron %A Wilroy,Jereme %A Young,Hui-Ju %A Howell,Jennifer %A Rimmer,James H %A Mehta,Tapan %A Thirumalai,Mohanraj %+ Department of Health Services Administration, University of Alabama at Birmingham, SHPB #590E, 1716 9th Avenue South, Birmingham, AL, 35233, United States, 1 2059347189, mohanraj@uab.edu %K exercise %K telehealth %K rehabilitation %K mHealth %D 2019 %7 19.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: People with physical disabilities (PWD) experience several unique challenges that prevent them from participating in onsite exercise programs. Although mobile apps can provide a ubiquitous channel for delivering convenient exercise services within the community, no exercise apps have been designed for people with disabilities who experience certain functional limitations. Objective: The aim of this study was to examine the usability of a mobile exercise app in PWD. Methods: A sequential explanatory mixed-method design was used to holistically test usability in 4 core areas: effectiveness (ie, ease of use), efficiency (ie, operation speed), perceived satisfaction, and usefulness. Participants completed 7 face-to-face usability tasks and 1 structured interview. Equipment included a computer tablet that came preinstalled with the exercise app. The app included exercise videos that focused on several components of fitness: aerobic capacity, muscular strength, functional strength or balance, and range of motion. The app contained 3 different versions of the exercise program: (1) a program for people with the ability to use the upper and lower limbs, (2) a seated program for people with the ability to use only upper limbs, and (3) a program designed for people with hemiparesis. The app also included educational resources in the form of infographics aimed at addressing key social cognitive theory constructs included social support, outcome expectancies, self-efficacy, and barriers or facilitators to exercising. Participant characteristics and quantitative usability data were descriptively reported. Qualitative data were analyzed using thematic analysis. Results: A total of 12 PWD tested the usability of the exercise app and completed 96% (69/72) of the usability tasks on the first attempt. Operation speed varied among users, which prompted the development team to make minor revisions to the app. Qualitative results demonstrated 3 overarching themes: facilitates exercise adoption, positive experiences of videos, and easy to learn. Participants noted that the app circumvented several barriers to exercise associated with leaving the home (eg, inclement weather conditions, exacerbations of health conditions or disability symptoms, difficulties with transportation, and social support). Conclusions: The mobile exercise app provided a simple platform that was effective, useful, and appreciated by PWD. Participants also perceived the app as easy to use and felt it was a valuable tool for assisting PWD to obtain regular exercise. Study findings also offered insight into the participants’ preferences for mobile exercise apps that can aid future research and development projects. Future exercise trials are needed to determine the true impact of mobile app technology on lifestyle physical activity in people with disabilities. Trial Registration: Clinicaltrials.gov NCT03024320; https://clinicaltrials.gov/ct2/show/NCT03024320 (Archived by WebCite at http://www.webcitation.org/75hNLgRFH). %M 30888325 %R 10.2196/11689 %U http://formative.jmir.org/2019/1/e11689/ %U https://doi.org/10.2196/11689 %U http://www.ncbi.nlm.nih.gov/pubmed/30888325 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e9922 %T What Is Being Used and Who Is Using It: Barriers to the Adoption of Smartphone Patient Experience Surveys %A Ng,Denise %A McMurray,Josephine %A Wallace,James %A Morita,Plinio %+ Business Technology Management, Lazaridis School of Business & Economics, Wilfrid Laurier University, 73 George Street, Brantford, ON, N3T3Y3, Canada, 1 5192427477, jmcmurray@wlu.ca %K quality of healthcare %K surveys and questionnaires %K patient satisfaction %K data collection %K smartphone %K mobile phone %K risk %K privacy %D 2019 %7 18.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Smartphones are positioned to transform the way health care services gather patient experience data through advanced mobile survey apps which we refer to as smart surveys. In comparison with traditional methods of survey data capture, smartphone sensing survey apps have the capacity to elicit multidimensional, in situ user experience data in real time with unprecedented detail, responsiveness, and accuracy. Objective: This study aimed to explore the context and circumstances under which patients are willing to use their smartphones to share data on their service experiences. Methods: We conducted in-person, semistructured interviews (N=24) with smartphone owners to capture their experiences, perceptions, and attitudes toward smart surveys. Results: Analysis examining perceived risk revealed a few barriers to use; however, major potential barriers to adoption were the identity of recipients, reliability of the communication channel, and potential for loss of agency. The results demonstrate that the classical dimensions of perceived risk raised minimal concerns for the use of smartphones to collect patient service experience feedback. However, trust in the doctor-patient relationship, the reliability of the communication channel, the altruistic motivation to contribute to health service quality for others, and the risk of losing information agency were identified as determinants in the patients’ adoption of smart surveys. Conclusions: On the basis of these findings, we provide recommendations for the design of smart surveys in practice and suggest a need for privacy design tools for voluntary, health-related technologies. %M 30882354 %R 10.2196/formative.9922 %U http://formative.jmir.org/2019/1/e9922/ %U https://doi.org/10.2196/formative.9922 %U http://www.ncbi.nlm.nih.gov/pubmed/30882354 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e9858 %T The Learning Exchange, a Community Knowledge Commons for Learning Networks: Qualitative Evaluation to Test Acceptability, Feasibility, and Utility %A McLinden,Daniel %A Myers,Sarah %A Seid,Michael %A Busch,Melida %A Davis,David %A Murphy,John %+ Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH,, United States, 1 513 803 0083, Michael.Seid@cchmc.org %K quality improvement %K knowledge management %K community networks %K intersectoral collaboration %K database management systems %K patient-centered care %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Learning Networks are distributed learning health systems that enable collaboration at scale to improve health and health care. A key requirement for such networks is having a way to create and share information and knowledge in furtherance of the work of the community. Objective: We describe a Learning Exchange—a bespoke, scalable knowledge management and exchange platform initially built and tested for improving pediatric inflammatory bowel disease outcomes in the ImproveCareNow (ICN) Network—and assess evidence of its acceptability, feasibility, and utility in facilitating creation and sharing of information in furtherance of the work of the community and as a model for other communities. Methods: Acceptability was assessed via growth in active users and activity. Feasibility was measured in terms of the percentage of users with a log-in who became active users as well as user surveys and a case study. Utility was measured in terms of the type of work that the Learning Exchange facilitated for the community. Results: The ICNExchange has over 1000 users and supported sharing of resources across all care centers in ICN. Users reported that the Learning Exchange has facilitated their work and resulted in increased ability to find resources relevant to local information needs. Conclusions: The ICNExchange is acceptable, feasible, and useful as a knowledge management and exchange platform in service of the work of ICN. Experience with the ICNExchange suggests that the design principles are extensible to other chronic care Learning Networks. %M 30869643 %R 10.2196/formative.9858 %U http://formative.jmir.org/2019/1/e9858/ %U https://doi.org/10.2196/formative.9858 %U http://www.ncbi.nlm.nih.gov/pubmed/30869643 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11785 %T The Development of an Arabic Weight-Loss App Akser Waznk: Qualitative Results %A Alturki,Ryan %A Gay,Valerie %+ School of Electrical and Data Engineering, Faculty of Engineering and Information Technology, University of Technology Sydney, 81 Broadway, Ultimo, Sydney, 2007, Australia, 61 410583330, ryan.m.alturki@student.uts.edu.au %K weight loss %K mobile app %K obesity %K physical activity %K smartphone %K mHealth %K motivation %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity and its related illnesses are a major health problem around the world. Saudi Arabia has one of the highest national obesity rates globally; however, it is not easy to intervene to prevent obesity and becoming overweight owing to Saudi Arabia’s cultural and social norms, and linguistic barriers. In recent years, there has been an exponential growth in the usage of smartphones and apps in Saudi Arabia. These could be used as a cost-effective tool to facilitate the delivery of behavior-modification interventions for obese and overweight people. There are a variety of health and fitness apps that claim to offer lifestyle-modification tools. However, these do not identify the motivational features required to overcome obesity, consider the evidence-based practices for weight management, or enhance the usability of apps by considering usability attributes. Objective: This study aimed to explore the opportunity and the need to develop an Arabic weight-loss app that provides localized content and addresses the issues with existing apps identified here. This study has explained the steps taken to design an Arabic weight-loss app that was developed to facilitate the adjustment of key nutritional and physical activities and behaviors, which considers the social and cultural norms of Saudi Arabia. Methods: Qualitative studies were conducted with 26 obese Saudi Arabians, who tested the level of usability of 2 weight-loss apps and then provided feedback and recommendations. The app Akser Waznk is an interactive, user-friendly app designed primarily for iPhones. It has several features intended to assist users to monitor and track their food consumption and physical activities. The app provides personalized diet and weight loss advice. Unique features such as Let’s Walk are designed to motivate users to walk more. An augmented reality function is implemented to provide information regarding fitness equipment, fruits, and vegetables. The app uses behavior-change techniques to increase activities and healthy behaviors and evidence-informed practices for weight-loss management. The Akser Waznk app considers user privacy and data security by applying a number of guidelines and procedures. Results: The development of the app took 26 months. In all, 7 experts (5 dietitians, and 2 physical activity professionals) evaluated the app’s contents. Moreover, 10 potential users (5 men and 5 women) tested the app’s level of usability, its features, and performance during a pilot study. They reported that the app’s design is interactive, and the motivational features are user-friendly. Conclusions: Mobile technology, such as mobile apps, has the potential to be an effective tool that facilitates the changing of unhealthy lifestyle behaviors within the Saudi community. To be successful, the target group, the usability, motivational features, and social and cultural norms must be considered. %M 30869639 %R 10.2196/11785 %U http://formative.jmir.org/2019/1/e11785/ %U https://doi.org/10.2196/11785 %U http://www.ncbi.nlm.nih.gov/pubmed/30869639 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11111 %T Co-Design of a Consultation Audio-Recording Mobile App for People With Cancer: The SecondEars App %A Lipson-Smith,Ruby %A White,Fiona %A White,Alan %A Serong,Lesley %A Cooper,Guy %A Price-Bell,Georgia %A Hyatt,Amelia %+ Cancer Experiences Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia, 61 3 8559 7837, amelia.hyatt@petermac.org %K referral and consultation %K adult %K humans %K cancer %K audiovisual aids %K mobile apps %K community-based participatory research %K health behavior %K psychological theory %D 2019 %7 12.03.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Many patients choose to audio-record their medical consultations so that they can relisten to them at home and share them with family. Consultation audio-recordings can improve patients’ recall and understanding of medical information and increase their involvement in decision making. A hospital-endorsed consultation audio-recording mobile app would provide patients with the permission and means to audio-record their consultations. The Theory of Planned Behavior provides a framework for understanding how patients can be encouraged to appropriately audio-record consultations. Objective: The aim of this study was to use a co-design process to develop a consultation audio-recording mobile app called SecondEars. Methods: App development began with stakeholder engagement, followed by a series of 6 co-design workshops and then user acceptance testing. Stakeholder engagement included advice from legal, information technology (IT), clinical and allied health leads; digital strategy; and medical records. he co-design workshops were attended by: patient consumers, members of the research team, IT staff, the app designers, clinicians, and staff from medical records. During workshops 1 to 4, the purpose and scope of the app were refined, possible pitfalls were addressed, and design features were discussed. The app designers then incorporated the results from these workshops to produce a wireframe mock-up of the proposed SecondEars app, which was presented for feedback at workshops 5 and 6. Results: The stakeholders identified 6 requirements for the app, including that it be patient driven, secure, clear in terms of legal responsibilities, linked to the patient’s medical record, and that it should require minimal upfront and ongoing resources. These requirements informed the scope of the co-design workshops. The workshops were attended by between 4 and 13 people. The workshop attendees developed a list of required features and suggestions for user interface design. The app developers used these requirements and recommendations to develop a prototype of the SecondEars app in iOS, which was then refined through user acceptance testing. Conclusions: The SecondEars app allows patients to have control and autonomy over audio-recording and sharing their consultations while maintaining privacy and safety for medical information and legal protection for clinicians. The app has been designed to have low upkeep and minimal impact on clinical processes. The SecondEars prototype is currently being tested with patients in a clinical setting. %M 30860487 %R 10.2196/11111 %U http://formative.jmir.org/2019/1/e11111/ %U https://doi.org/10.2196/11111 %U http://www.ncbi.nlm.nih.gov/pubmed/30860487 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11950 %T Using Exploratory Trials to Identify Relevant Contexts and Mechanisms in Complex Electronic Health Interventions: Evaluating the Electronic Patient-Reported Outcome Tool %A Steele Gray,Carolyn %A Gravesande,Janelle %A Hans,Parminder Kaur %A Nie,Jason X %A Sharpe,Sarah %A Loganathan,Mayura %A Lyons,Renee %A Cott,Cheryl %+ Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, ON, M4M 2B5, Canada, 1 416 461 8252 ext 2908, Carolyn.SteeleGray@sinaihealthsystem.ca %K eHealth %K mHealth %K multiple chronic conditions %K clinical trial, phase III %K health care evaluation mechanisms %K quantitative evaluation %K qualitative evaluation %K narrative analysis %D 2019 %7 27.02.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Designing appropriate studies for evaluating complex interventions, such as electronic health solutions to support integrated care, remains a methodological challenge. With the many moving parts of complex interventions, it is not always clear how program activities are connected to anticipated and unanticipated outcomes. Exploratory trials can be used to uncover determinants (or mechanisms) to inform content theory that underpins complex interventions before designing a full evaluation plan. Objective: A multimethod exploratory trial of the electronic patient-reported outcome (ePRO) tool was conducted to uncover contexts, processes and outcome variables, and the mechanisms that link these variables before full-scale evaluation. ePRO is a mobile app and portal designed to support goal-oriented care in interdisciplinary primary health care practices (clinical-level integration). This paper offers evaluation findings and methodological insight on how to use exploratory trial data to identify relevant context, process, and outcome variables, as well as central (necessary to achieving outcomes) versus peripheral (less critical and potentially context dependent) mechanisms at play. Methods: The 4-month trial was conducted in 2 primary health care practices in Toronto, Canada. The patients were randomized into control and intervention groups and compared pre and post on quality of life and activation outcome measures. Semistructured interviews were conducted with providers and patients in the intervention group. Narrative analysis was used to uncover dominant mechanisms that inform the intervention’s content theory (how context and process variables are linked to outcomes). Results: Overall, 7 providers, 1 administrator, and 16 patients (7-control, 9-intervention) participated in the study. This study uncovered many complex and nuanced context, process, and outcome variables at play in the intervention. Narrative analysis of patient and provider interviews revealed dominant story lines that help to tease apart central and peripheral mechanisms driving the intervention. Provider and patient story lines centered around fitting the new intervention into everyday work and life of patients and providers and meaningfulness of the intervention. These themes were moderated by patient-provider relationships going into and throughout the intervention, their comfort with technology, and the research process. Conclusions: Identifying dominant story lines using narrative analysis helps to identify the most relevant context and process variables likely to influence study outcomes. Normalization process theory emerges as a useful theory to uncover underlying mechanisms because of its emphasis on the social production and normalization of technological, processual, and social aspects of work; all found to be critical to our intervention. The number of complex, overlapping influencing variables suggests that complex interventions such as ePRO require us to pay careful attention to central versus peripheral mechanisms that will influence study outcomes. The narrative methods presented here are shown to be useful in uncovering these mechanisms and help to guide subsequent larger evaluation studies. %M 30810532 %R 10.2196/11950 %U http://formative.jmir.org/2019/1/e11950/ %U https://doi.org/10.2196/11950 %U http://www.ncbi.nlm.nih.gov/pubmed/30810532 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e9435 %T Using Mobile Technology to Improve Bone-Related Lifestyle Risk Factors in Young Women With Low Bone Mineral Density: Feasibility Randomized Controlled Trial %A Subasinghe,Asvini Kokila %A Garland,Suzanne Marie %A Gorelik,Alexandra %A Tay,Ilona %A Wark,John Dennis %+ Infection and Immunity Theme, Murdoch Children's Research Institute, Level 7, Royal Women's Hospital, 20 Flemington Road, Parkville,, Australia, 61 03 8345 3692, asvini.subasinghe@gmail.com %K behavior therapy methods %K mobile phones %K health behavior %K primary prevention methods %K self-care methods %D 2019 %7 25.02.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor bone health in adolescent and young adult females is a growing concern. Given the widespread use of mobile phones in this population, mobile health (mHealth) interventions may help improve health behaviors related to bone health in young women. Objective: The goal of the study was to determine the acceptability and feasibility of an mHealth intervention called Tap4Bone in improving health behaviors associated with the risk of osteoporosis in young women. Methods: The Tap4Bone mHealth intervention comprised the use of mobile phone apps, short messaging service (text messaging), and Web emails to encourage health behavior changes. The education group received osteoporosis prevention education leaflets. Changes in the bone health–related behaviors exercise, smoking, and calcium intake were assessed. User experiences and acceptance of the app were collected through focus group interviews. Results: A total of 35 (22 completed, mean age 23.1 [SD 1.8] years) were randomized to either the mobile phone (intervention n=18) or education (control n=17) group. Although there were trends toward improvement in calcium intake, sports activity, and smoking behaviors in the mHealth intervention group compared to the education group, these were not statistically significant. Conclusions: The Tap4Bone mHealth intervention was shown to be acceptable and feasible in subsets of the participants. The intervention should be improved upon using participant feedback to improve functionality. Findings from this study may aid in the development and modification of health care apps to reduce participant attrition. %M 30801253 %R 10.2196/formative.9435 %U http://formative.jmir.org/2019/1/e9435/ %U https://doi.org/10.2196/formative.9435 %U http://www.ncbi.nlm.nih.gov/pubmed/30801253 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e10284 %T Digital Gaming for Nutritional Education: A Survey on Preferences, Motives, and Needs of Children and Adolescents %A Holzmann,Sophie Laura %A Dischl,Felicitas %A Schäfer,Hanna %A Groh,Georg %A Hauner,Hans %A Holzapfel,Christina %+ Institute for Nutritional Medicine, Else Kroener-Fresenius-Center for Nutritional Medicine, University Hospital “Klinikum rechts der Isar”, Technical University of Munich, Georg-Brauchle-Ring 62, 5th Floor, Munich, 80992, Germany, 49 89 289 249 23, christina.holzapfel@tum.de %K adolescents %K children %K communication %K motives %K mobile phone %K needs %K nutrition %K obesity %K overweight %K preferences %K serious games %K survey %D 2019 %7 13.02.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Use of novel information and communication technologies are frequently discussed as promising tools to prevent and treat overweight and obesity in children and adolescents. Objective: This survey aims to describe the preferences, motives, and needs of children and adolescents regarding nutrition and digital games. Methods: We conducted a survey in 6 secondary schools in the southern region of Germany using a 43-item questionnaire. Questions referred to preferences, motives, and needs of children and adolescents regarding nutrition and digital games. In addition, knowledge regarding nutrition was assessed with 4 questions. We collected self-reported sociodemographic and anthropometric data. Descriptive statistical analyses were performed using SPSS. Results: In total, 293 children and adolescents participated in the study, with ages 12-18 years (137 girls, 46.8%), weight 30.0-120.0 (mean 60.2 [SD 13.2]) kg, and height 1.4-2.0 (mean 1.7 [SD 0.1]) m. A total of 5.5% (16/290) correctly answered the 4 questions regarding nutrition knowledge. Study participants acquired digital nutritional information primarily from the internet (166/291, 57.0%) and television (97/291, 33.3%), while school education (161/291, 55.3%) and parents or other adults (209/291, 71.8%) were the most relevant nondigital information sources. Most participants (242/283, 85.5%) reported that they regularly play digital games. More than half (144/236, 61.0%) stated that they play digital games on a daily basis on their smartphones or tablets, and almost 70% (151/282, 66.5%) reported playing digital games for ≤30 minutes without any interruption. One-half of respondents (144/280, 51.4%) also stated that they were interested in receiving information about nutrition while playing digital games. Conclusions: This survey suggests that nutrition knowledge in children and adolescents might be deficient. Most children and adolescents play digital games and express interest in acquiring nutritional information during digital gameplay. A digital game with a focus on sound nutrition could be a potential educational tool for imparting nutrition knowledge and promoting healthier nutrition behaviors in children and adolescents. %M 30758290 %R 10.2196/10284 %U http://formative.jmir.org/2019/1/e10284/ %U https://doi.org/10.2196/10284 %U http://www.ncbi.nlm.nih.gov/pubmed/30758290 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e12528 %T A Digital Modality Decision Program for Patients With Advanced Chronic Kidney Disease %A Dubin,Ruth %A Rubinsky,Anna %+ San Francisco Veterans Affairs Medical Center, 4150 Clement Street, Box 111J, San Francisco, CA, 94121, United States, 1 5108474955, ruth.dubin@ucsf.edu %K chronic kidney disease %K end-stage renal disease %K online social networking %K patient education %K renal dialysis %D 2019 %7 06.02.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient education regarding end-stage renal disease (ESRD) has the potential to reduce adverse outcomes and increase the use of in-home renal replacement therapies. Objective: This study aimed to investigate whether an online, easily scalable education program can improve patient knowledge and facilitate decision making regarding renal replacement therapy options. Methods: We developed a 4-week online, digital educational program that included written information, short videos, and social networking features. Topics included kidney transplant, conservative management, peritoneal dialysis, in-home hemodialysis, and in-center hemodialysis. We recruited patients with advanced chronic kidney disease (stage IV and V) to enroll in the online program, and we evaluated the feasibility and potential impact of the digital program by conducting pre- and postintervention surveys in areas of knowledge, self-efficacy, and choice of ESRD care. Results: Of the 98 individuals found to be eligible for the study, 28 enrolled and signed the consent form and 25 completed the study. The average age of participants was 65 (SD 15) years, and the average estimated glomerular filtration rate was 21 (SD 6) ml/min/1.73 m2. Before the intervention, 32% of patients (8/25) were unable to make an ESRD treatment choice; after the intervention, all 25 participants made a choice. The proportion of persons who selected kidney transplant as the first choice increased from 48% (12/25) at intake to 84% (21/25) after program completion (P=.01). Among modality options, peritoneal dialysis increased as the first choice for 4/25 (16%) patients at intake to 13/25 (52%) after program completion (P=.004). We also observed significant increases in knowledge score (from 65 [SD 56] to 83 [SD 14]; P<.001) and self-efficacy score (from 3.7 [SD 0.7] to 4.3 [SD 0.5]; P<.001). Conclusions: Implementation of a digital ESRD education program is feasible and may facilitate patients’ decisions about renal replacement therapies. Larger studies are necessary to understand whether the program affects clinical outcomes. Trial Registration: ClinicalTrials.gov NCT02976220; https://clinicaltrials.gov/ct2/show/NCT02976220 %M 30724735 %R 10.2196/12528 %U http://formative.jmir.org/2019/1/e12528/ %U https://doi.org/10.2196/12528 %U http://www.ncbi.nlm.nih.gov/pubmed/30724735 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e12508 %T Impact of Food Preparation Video Exposure on Online Nutrition Education in Women, Infants, and Children (WIC) Program Participants: Retrospective Study %A Bensley,Robert J %A Brusk,John J %+ School of Interdisciplinary Health Programs, Western Michigan University, 2414 CHHS Building, 1903 W Michigan Avenue, Kalamazoo, MI, 49008, United States, 1 269 716 2301, bensley@wmich.edu %K internet %K online video %K WIC %K engagement %D 2019 %7 23.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The impact of integrating video into health education delivery has been extensively investigated; however, the effect of integrating video on a learner’s subsequent performance in an online educational setting is rarely reported. Results of the relationship between the learner’s online video viewing and subsequent progression toward health behavior change in a self-directed online educational session are lacking. Objective: This study aimed to determine the relationship between viewing a Health eKitchen online video and key engagement performance indicators associated with online nutrition education for women, infants, and children (WIC). Methods: This study involved a retrospective cohort of users grouped on the basis of whether Health eKitchen exposure occurred before or after completing a nutrition education lesson. A two-sample test for equality of proportions was performed to test the difference in the likelihood of progression between the groups overall and when stratified by lesson type, which was defined by whether the lesson focused on food preparation. Welch two-sample t tests were performed to test the difference in average link depth and duration of use between groups overall and stratified by lesson type. Logistic regression was conducted to validate the impact of video viewing prior to lesson completion while controlling for lesson type and factors known to be associated with WIC key performance indicators. Results: A greater stage of change progression was observed for both food preparation (χ2=12.6, P<.001) and non-food preparation (χ2=62.8, P<.001) lessons among early stage users who had viewed a Health eKitchen video before completing a lesson. Time spent viewing educational learning resource links within the lesson was also significantly longer for both food preparation (t=7.8, P<.001) and non-food preparation (t=2.5, P=.01) lessons. Logistic regression analysis corroborated these results while controlling for known confounding factors. The odds of user progression were nearly three times greater among those who viewed a Health eKitchen video prior to lesson completion (odds ratio=2.61; 95% CI=2.08-3.29). Type of lesson (food vs non-food preparation) was the strongest predictor of progression odds (odds ratio=3.12; 95% CI=2.47-3.95). Conclusions: User access to a Health eKitchen video prior to completion of an online educational session had a significant impact on achieving lesson goals, regardless of the food preparation focus. This observation suggests the potential benefit of providing an application-oriented video at the onset of online nutrition education lessons. %R 10.2196/12508 %U http://formative.jmir.org/2019/1/e12508/ %U https://doi.org/10.2196/12508 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e10978 %T Design, Development, and Evaluation of an Injury Surveillance App for Cricket: Protocol and Qualitative Study %A Soomro,Najeebullah %A Chhaya,Meraj %A Soomro,Mariam %A Asif,Naukhez %A Saurman,Emily %A Lyle,David %A Sanders,Ross %+ Broken Hill University Department of Rural Health, University of Sydney, Corrindah Court, Broken Hill, 2880, Australia, 61 880801282, naj.soomro@sydney.edu.au %K cricket %K injury surveillance %K mobile app %K mobile phone %K TeamDoc %K mHealth %D 2019 %7 22.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Injury surveillance and workload monitoring are important aspects of professional sports, including cricket. However, at the community level, there is a dearth of accessible and intelligent surveillance tools. Mobile apps are an accessible tool for monitoring cricket-related injuries at all levels. Objective: The objective of this paper is to share the novel methods associated with the development of the free TeamDoc app and provide evidence from an evaluation of the user experience and perception of the app regarding its functionality, utility, and design. Methods: TeamDoc mobile app for Android and Apple smartphones was developed using 3 languages: C++, Qt Modeling Language, and JavaScript. For the server-side connectivity, Hypertext Preprocessor (PHP) was used as it is a commonly used cross-platform language. PHP includes components that interact with popular database management systems, allowing for secure interaction with databases on a server level. The app was evaluated by administrating a modified user version of the Mobile App Rating Scale (uMARS; maximum score: 5). Results: TeamDoc is the first complementary, standalone mobile app that records cricket injuries through a smartphone. It can also record cricketing workloads, which is a known risk factor for injury. The app can be used without the need for supplementary computer devices for synchronization. The uMARS scores showed user satisfaction (overall mean score 3.6 [SD 0.5]), which demonstrates its acceptability by cricketers. Conclusions: Electronic injury surveillance systems have been shown to improve data collection during competitive sports. Therefore, TeamDoc may assist in improving injury reporting and may also act as a monitoring system for coaching staff to adjust individual training workloads. The methods described in this paper provide a template for researchers to develop similar apps for other sports. %M 30668516 %R 10.2196/10978 %U http://mhealth.jmir.org/2019/1/e10978/ %U https://doi.org/10.2196/10978 %U http://www.ncbi.nlm.nih.gov/pubmed/30668516 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e11509 %T Feasibility of a Therapist-Supported, Mobile Phone–Delivered Online Intervention for Depression: Longitudinal Observational Study %A Goldin,Philippe R %A Lindholm,Riku %A Ranta,Kristian %A Hilgert,Outi %A Helteenvuori,Tiia %A Raevuori,Anu %+ Betty Irene Moore School of Nursing, University of California Davis, 4610 X Street, Sacramento, CA, 95817, United States, 1 4156769793, philippegoldin@gmail.com %K cognitive therapy %K depression %K digital health %K digital therapeutics %K mindfulness %K online intervention %D 2019 %7 22.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Depression is a very common condition that impairs functioning and is often untreated. More than 60% of the treatments for depressive disorder are administered in primary care settings by care providers who lack the time and expertise to treat depression. To address this issue, we developed Ascend, a therapist-supported, mobile phone–delivered 8-week intervention administered at the Meru Health Online Clinic in Finland. Objective: We conducted two pilot studies to examine the feasibility of the Ascend intervention, specifically, dropout rates, daily practice, weekly group chat use, and changes in depression symptoms. We also explored whether daily practice and weekly group chat use were associated with changes in depression symptoms. Methods: A total of 117 Finnish adults with elevated depressive symptoms enrolled in Ascend, a program that included daily cognitive behavioral and mindfulness meditation exercises delivered through a mobile phone app, anonymous group chat with other users, and chat/phone access to a licensed therapist. Eight weekly themes were delivered in a fixed, sequential format. Depression symptoms were measured at baseline, every second week during the intervention, immediately after the intervention, and 4 weeks after completion of the intervention. Data were analyzed using intent-to-treat repeated-measures analysis of variance and linear regression models. Results: For studies 1 and 2, we observed dropout rates of 27% and 15%, respectively, decreasing daily practice and group chat use, and decreased depression symptoms from baseline to immediately and 4 weeks after the intervention (P<.001). We found that both more daily practice and chat group use predicted the occurrence of fewer depressive symptoms at 4 weeks postintervention (Study 1: ∆R2=.38, P=.004 and ∆R2=.38, P=.002, respectively; Study 2: ∆R2=.16, P<.001 and ∆R2=.08, P=.002, respectively). Conclusions: This therapist-supported, mobile phone–delivered treatment for depression is feasible and associated with reduced depression symptoms. Design features that enhance daily practice and group chat use are areas of future investigation. Validation of these results using a controlled study design is needed to establish the evidence base for the Ascend intervention. %R 10.2196/11509 %U http://formative.jmir.org/2019/1/e11509/ %U https://doi.org/10.2196/11509 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e12227 %T Use of a Biofeedback Breathing App to Augment Poststress Physiological Recovery: Randomized Pilot Study %A Plans,David %A Morelli,Davide %A Sütterlin,Stefan %A Ollis,Lucie %A Derbyshire,Georgia %A Cropley,Mark %+ Faculty of Health and Medical Sciences, School of Psychology, University of Surrey, School of Psychology, Stag Hill, Guildford, GU2 7XH, United Kingdom, 44 01483686928, mark.cropley@surrey.ac.uk %K biofeedback %K breathing %K heart rate variability %K recovery %K rumination %K stress %D 2019 %7 11.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The speed of physiological recovery from stress may be a marker for cardiovascular disease risk. Stress management programs that incorporate guided breathing have been shown to moderate the stress response and augment recovery. Objective: The aim of this study was to examine the effectiveness of an app-based brief relaxation intervention (BioBase) for facilitating physiological recovery in individuals exposed to a brief psychological stressor. Methods: A total of 75 participants (44 women) completed a stressor speech task and were randomly assigned to one of three conditions: control, rumination, or an app-based relaxation breathing (BioBase) conditions. Heart rate variability (HRV) was assessed as a measure of autonomic function at baseline (6 min), during stress (6 min), and during recovery (6 min). Results: There was a significant increase in subjective stress following stress exposure, but the ratings returned to baseline after recovery in all three groups. In addition, there was a significant decrease in vagally mediated HRV in the poststress period. During recovery, the root mean square of successive differences (P<.001), the percentage of successive interbeat (RR) intervals that differ by >50 ms (pNN50; P<.001), and high-frequency (P<.02) HRV were significantly higher in the BioBase breathing condition than the rumination and control conditions. There was no difference in HRV values between the rumination and control conditions during recovery. Conclusions: App-based relaxed breathing interventions could be effective in reducing cardiovascular disease risk. These results provide additional utility of biofeedback breathing in augmenting physiological recovery from psychological stress. %M 30684437 %R 10.2196/12227 %U https://formative.jmir.org/2019/1/e12227/ %U https://doi.org/10.2196/12227 %U http://www.ncbi.nlm.nih.gov/pubmed/30684437 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e10246 %T Evaluation of a Mobile Device Survey System for Behavioral Risk Factors (SHAPE): App Development and Usability Study %A Oakley-Girvan,Ingrid %A Lavista,Juan M %A Miller,Yasamin %A Davis,Sharon %A Acle,Carlos %A Hancock,Jeffrey %A Nelson,Lorene M %+ Public Health Institute, 555 12th Street, 10th Floor, Oakland, CA,, United States, 1 4086562948, oakley@stanford.edu %K mobile phone %K demographic characteristics %K health surveys %K risk behaviors %K mobile apps %D 2019 %7 11.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Risk factors, including limited exercise, poor sleep, smoking, and alcohol and drug use, if mitigated early, can improve long-term health. Risk prevalence has traditionally been measured using methods that now have diminished participation rates. With >75% of American citizens owning smartphones, new data collection methods using mobile apps can be evaluated. Objective: The objective of our study was to describe the development, implementation, and evaluation of a mobile device–based survey system for behavioral risk assessment. Specifically, we evaluated its feasibility, usability, acceptability, and validity. Methods: We enrolled 536 students from 3 Vermont State Colleges. Iterative mobile app development incorporated focus groups, extensive testing, and the following 4 app versions: iOS standard, iOS gamified, Android standard, and Android gamified. We aimed to capture survey data, paradata, and ambient data such as geolocation. Using 3 separate surveys, we asked a total of 27 questions that included demographic characteristics, behavioral health, and questions regarding the app’s usability and survey process. Results: Planned enrollment was exceeded in just a few days. There were 1392 “hits” to the landing page where the app could be downloaded. Excluding known project testers and others not part of the study population, 670 participants downloadeded the SHAPE app. Of those, 94.9% of participants (636/670) agreed to participate by providing in-app consent. Of the 636 who provided consent, 84.3% (536/636) were deemed eligible for the study. The majority of eligible respondents completed the initial survey (459/536, 85.6%), whereas 29.9% (160/536) completed the second survey and 28.5% (153/536) completed the third survey. The SHAPE survey obtained 414 participants on the behavioral risk items in survey 1, which is nearly double the 209 participants who completed the traditional Vermont College Health Survey in 2014. SHAPE survey responses were consistent with the traditionally collected Vermont College Health Survey data. Conclusions: This study provides data highlighting the potential for mobile apps to improve population-based health, including an assessment of recruitment methods, burden and response rapidity, and future adaptations. Although gamification and monetary rewards were relatively unimportant to this study population, item response theory may be technologically feasible to reduce individual survey burden. Additional data collected by smartphones, such as geolocation, could be important in additional analysis, such as neighborhood characteristics and their impact on behavioral risk factors. Mobile tools that offer rapid adaptation for specific populations may improve research data collection for primary prevention and could be used to improve engagement and health outcomes. %M 30684441 %R 10.2196/10246 %U https://formative.jmir.org/2019/1/e10246/ %U https://doi.org/10.2196/10246 %U http://www.ncbi.nlm.nih.gov/pubmed/30684441 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e12456 %T A Virtual Reality Food Court to Study Meal Choices in Youth: Design and Assessment of Usability %A Allman-Farinelli,Margaret %A Ijaz,Kiran %A Tran,Helen %A Pallotta,Hermes %A Ramos,Sidney %A Liu,Junya %A Wellard-Cole,Lyndal %A Calvo,Rafael A %+ Charles Perkins Centre, School of Life and Environmental Sciences, University of Sydney, Building D17, NSW, 2006, Australia, 61 0290367045, margaret.allmanfarinelli@sydney.edu.au %K virtual reality %K nutrition promotion %K food policy %K take-out food %K obesity %K young adults %D 2019 %7 09.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Regular consumption of take-out and fast foods with sugary drinks is associated with poor quality diets and higher prevalence of obesity. Among the settings where such food is consumed is the food court typically found in shopping malls prominent in many countries. Objective: The objective of this research was to develop a virtual reality food court that could be used to test food environmental interventions, such as taxation, and ultimately to facilitate the selection of healthier food choices. Methods: Fourteen food courts in Sydney, Australia were selected to include those in the city center and suburbs of high and low socioeconomic status. Researchers visited the courts to collect information on number and type of food outlets, all menu items for sale, cost of foods and beverages and sales promotions. This information was used to assemble 14 food outlets typically found in food courts, and representative menus were compiled. The UNITY gaming platform was used to design a virtual reality food court that could be used with HTC VIVE goggles. Participants navigated the virtual reality food court using the head-mounted display, keyboard, and mouse and selected a lunch meal, including food and beverage. A validated questionnaire on presence within the virtual reality food court and system usability was completed at the end of the session. The constructs for presence included a sense of control, sensory fidelity, realism, distraction, and involvement. Questions were rated on a scale from 1 (worst) through 7 (best) for each of 28 questions giving a maximum total score of 196. The systems usability scale (SUS) that gives a final score out of 100 was also assessed. Results: One hundred and sixty-two participants with a mean age of 22.5 (SD 3.1) years completed the survey. The mean score for total presence was 144 (SE 1.4) consisting of control: 62.1 (SE 0.8), realism: 17.5 (SE 0.2), involvement: 9.6 (SE 0.2), sensory fidelity: 34.9 (SE 0.4), and distraction: 24.0 (SE 0.3). The mean SUS was 69 (SE 1.1). Conclusions: Virtual reality shows promise as a tool to study food choice for test interventions to inform practice and policy. %M 30684440 %R 10.2196/12456 %U http://formative.jmir.org/2019/1/e12456/ %U https://doi.org/10.2196/12456 %U http://www.ncbi.nlm.nih.gov/pubmed/30684440 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e10944 %T Community Engagement in the Development of an mHealth-Enabled Physical Activity and Cardiovascular Health Intervention (Step It Up): Pilot Focus Group Study %A Ceasar,Joniqua Nashae %A Claudel,Sophie Elizabeth %A Andrews,Marcus R %A Tamura,Kosuke %A Mitchell,Valerie %A Brooks,Alyssa T %A Dodge,Tonya %A El-Toukhy,Sherine %A Farmer,Nicole %A Middleton,Kimberly %A Sabado-Liwag,Melanie %A Troncoso,Melissa %A Wallen,Gwenyth R %A Powell-Wiley,Tiffany M %+ National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5332, MSC 1454, 10 Center Drive, Bethesda, MD, 20892, United States, 1 301 594 3735, tiffany.powell-wiley@nih.gov %K cardiovascular health %K community-based participatory research %K health behaviors %K mHealth %K mobile phone %K physical activity %K qualitative data %D 2019 %7 04.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Community-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans. Objective: This study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC. Methods: We recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participants’ experiences of using the app. FGs were audiorecorded and transcribed verbatim, with subsequent behavioral theory-driven thematic analysis. Key themes based on the Health Belief Model and emerging themes were identified from the transcripts. Three independent reviewers iteratively coded the transcripts until consensus was reached. Then, the final codebook was approved by a qualitative research expert. Results: In this study, 10 main themes emerged. Participants emphasized the need to improve the app by optimizing automation, increasing relatability (eg, photos that reflect target demographic), increasing educational material (eg, health information), and connecting with community resources (eg, cooking classes and exercise groups). Conclusions: Involving target users in the development of a culturally sensitive PA app is an essential step for creating an app that has a higher likelihood of acceptance and use in a technology-enabled intervention. This may decrease health disparities in cardiovascular diseases by more effectively increasing PA in a minority population. %M 30684422 %R 10.2196/10944 %U https://formative.jmir.org/2019/1/e10944/ %U https://doi.org/10.2196/10944 %U http://www.ncbi.nlm.nih.gov/pubmed/30684422 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e10858 %T Mobile Device Use Among Rural, Low-Income Families and the Feasibility of an App to Encourage Preschoolers’ Physical Activity: Qualitative Study %A McCloskey,Morgan L %A Thompson,Darcy A %A Chamberlin,Barbara %A Clark,Lauren %A Johnson,Susan L %A Bellows,Laura L %+ Department of Food Science and Human Nutrition, Colorado State University, 1571 Campus Delivery, Fort Collins, CO, 80523 1571, United States, 1 9704911305, laura.bellows@colostate.edu %K smartphone %K mobile apps %K families %K child, preschool %K physical activity %K rural population %K poverty %D 2018 %7 06.12.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: As mobile devices are becoming ubiquitous, technology-based interventions provide a promising strategy to positively influence health behaviors of families with young children. However, questions remain about the feasibility and acceptability of intervention delivery via mobile apps in low-income, rural settings and among families with preschoolers. Objective: The aims of this study were to understand the content and context of mobile device use for preschoolers; explore parent beliefs on this topic, including the acceptability of intervention delivery via mobile devices; and test a prototype of an app to encourage preschoolers’ physical activity with both parents and children. Methods: Parents (n=29) were recruited from 5 preschool centers in eastern, rural Colorado to complete a semistructured telephone interview regarding preschoolers’ mobile device use. A second sample of parents (n=31) was recruited from the same preschool centers to view the app prototype independently and provide feedback. A third sample of preschool children (n=24) was videotaped using the app in small groups to measure engagement and record their responses to the app. Results: Five key content areas emerged from the telephone interviews: (1) mobile devices are an important part of families’ everyday routines, and parents have parameters governing their use; (2) parents often use mobile devices as a tool for behavior management; (3) parents clearly distinguish between mobile device use for learning versus entertainment; (4) parents have an overarching desire for balance in regard to their child’s mobile device use; and (5) parents were generally supportive of the idea of using mobile apps for intervention delivery. From the app prototype testing with parents, participants reacted positively to the app and felt that it would be useful in a variety of situations. Testing with preschoolers showed the children were highly engaged with the app and a majority remained standing and/or actively moving through the entire length of the app. Conclusions: Mobile devices are already integrated into most families’ daily routines and appear to be an acceptable method of intervention delivery in low-income families in rural Colorado. The physical activity app represents an innovative way to reach these families and, with further improvements based on participant feedback, will provide children with a unique opportunity to practice key movement skills. %M 31518295 %R 10.2196/10858 %U http://pediatrics.jmir.org/2018/2/e10858/ %U https://doi.org/10.2196/10858 %U http://www.ncbi.nlm.nih.gov/pubmed/31518295 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 12 %P e12077 %T The Internet of Things in Health Care in Oxford: Protocol for Proof-of-Concept Projects %A Meinert,Edward %A Van Velthoven,Michelle %A Brindley,David %A Alturkistani,Abrar %A Foley,Kimberley %A Rees,Sian %A Wells,Glenn %A de Pennington,Nick %+ Healthcare Translation Research Group, Department of Paediatrics, University of Oxford, Level 2, Children's Hospital, John Radcliffe, Oxford, OX3 9DU, United Kingdom, 44 7824446808, edward.meinert@paediatrics.ox.ac.uk %K Internet %K computer systems %K computing methodologies %K information systems %K information storage and retrieval %K dataset %K patient care %K health services %K Internet of Things %K Internet of Medical Things %D 2018 %7 04.12.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Demands on health services across are increasing because of the combined challenges of an expanding and aging population, alongside complex comorbidities that transcend the classical boundaries of modern health care. Continuing to provide and coordinate care in the current manner is not a viable route to sustain the improvements in health outcomes observed in recent history. To ensure that there continues to be improvement in patient care, prevention of disease, and reduced burden on health systems, it is essential that we adapt our models of delivery. Providers of health and social care are evolving to face these pressures by changing the way they think about the care system and, importantly, how to involve patients in the planning and delivery of services. Objective: The objective of this paper is to provide (1) an overview of the current state of Internet of Things (IoT) and key implementation considerations, (2) key use cases demonstrating technology capabilities, (3) an overview of the landscape for health care IoT use in Oxford, and (4) recommendations for promoting the IoT via collaborations between higher education institutions and industry proof-of-concept (PoC) projects. Methods: This study describes the PoC projects that will be created to explore cost-effectiveness, clinical efficacy, and user adoption of Internet of Medical Things systems. The projects will focus on 3 areas: (1) bring your own device integration, (2) chronic disease management, and (3) personal health records. Results: This study is funded by Research England’s Connecting Capability Fund. The study started in March 2018, and results are expected by the end of 2019. Conclusions: Embracing digital solutions to support the evolution and transformation of health services is essential. Importantly, this should not simply be undertaken by providers in isolation. It must embrace and exploit the advances being seen in the consumer devices, national rollout of high-speed broadband services, and the rapidly expanding medical device industry centered on mobile and wearable technologies. Oxford University Hospitals and its partner providers, patients, and stakeholders are building on their leading position as an exemplar site for digital maturity in the National Health Service to implement and evaluate technologies and solutions that will capitalize on the IoT. Although early in the application to health, the IoT and the potential it provides to make the patient a partner at the center of decisions about care represent an exciting opportunity. If achieved, a fully connected and interoperable health care environment will enable continuous acquisition and real-time analysis of patient data, offering unprecedented ability to monitor patients, manage disease, and potentially deliver early diagnosis. The clinical benefit of this is clear, but additional patient benefit and value will be gained from being able to provide expert care at home or close to home. International Registered Report Identifier (IRRID): DERR1-10.2196/12077 %M 30514695 %R 10.2196/12077 %U http://www.researchprotocols.org/2018/12/e12077/ %U https://doi.org/10.2196/12077 %U http://www.ncbi.nlm.nih.gov/pubmed/30514695 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e25 %T Behavior Change for Youth Drivers: Design and Development of a Smartphone-Based App (BackPocketDriver) %A Warren,Ian %A Meads,Andrew %A Whittaker,Robyn %A Dobson,Rosie %A Ameratunga,Shanthi %+ Department of Computer Science, University of Auckland, Science Centre Building, 38 Princess Street, Auckland, 1010, New Zealand, 64 9 373 7599 ext 88784, ian-w@cs.auckland.ac.nz %K smartphone %K public health %K telemedicine %K telemetry %D 2018 %7 26.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The over-representation of youth in road crash injury and fatality rates is a major public health issue globally. In New Zealand, youth drivers are most vulnerable in the restricted license period when they can drive without the requirement for supervision by an experienced adult. Behavioral change interventions delivered using mobile phone technology to young drivers could serve as a useful mechanism to develop safe driving skills, but this potential remains to be fully explored. Objective: This study aimed to apply behavioral change principles to design and develop a smartphone-based intervention with the aim of helping youth drivers to develop and hone safe driving skills. Methods: An iterative process was used to support development of the smartphone intervention. We reviewed behavioral change literature, identifying fundamental principles and exploring use of behavior change techniques (BCTs) in other areas of public health. We engaged with key stakeholders, including young drivers, government agencies, and relevant organizations. We also took into account technology adoption considerations when designing the app. Results: We developed BackPocketDriver (BPD), an Android smartphone app that uses in-built sensors to monitor and infer driver behavior. The app implements features that were identified during the design process and are traceable to BCTs and theory. A key feature is messaging, which is used to instruct, motivate, educate, and relay feedback to participants. In addition, messaging addresses attitudes and beliefs. Other features include journey feedback summaries, goal setting, achievements, and leaderboards. Conclusions: BPD’s design rests on a sound foundation of theory and evidence. With explicit links between theory and features, the app aims to be an effective intervention to change and improve youth driver behavior. The next phase of this study is to run a small pilot study to assess BPD’s effectiveness. %M 30684435 %R 10.2196/formative.9660 %U http://formative.jmir.org/2018/2/e25/ %U https://doi.org/10.2196/formative.9660 %U http://www.ncbi.nlm.nih.gov/pubmed/30684435 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e22 %T Assessing the Needs and Perspectives of Patients With Asthma and Chronic Obstructive Pulmonary Disease on Patient Web Portals: Focus Group Study %A Metting,Esther %A Schrage,Aaltje Jantine %A Kocks,Janwillem WH %A Sanderman,Robbert %A van der Molen,Thys %+ Groningen Research Institute for Asthma and COPD, Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 4, Groningen, 9713 AW, Netherlands, 31 6 2564 7087, e.i.metting@umcg.nl %K asthma %K chronic obstructive pulmonary disease %K health care %K health literacy %K internet %K electronic medical record %K self-management %D 2018 %7 22.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: As accessibility to the internet has increased in society, many health care organizations have developed patient Web portals (PWPs), which can provide a range of self-management options to improve patient access. However, the available evidence suggests that they are used inefficiently and do not benefit patients with low health literacy. Asthma and chronic obstructive pulmonary disease (COPD) are common chronic diseases that require ongoing self-management. Moreover, patients with COPD are typically older and have lower health literacy. Objective: This study aimed to obtain and present an overview of patients’ perspectives of PWPs to facilitate the development of a portal that better meets the needs of patients with asthma and COPD. Methods: We performed a focus group study using semistructured interviews in 3 patient groups from the north of the Netherlands who were recruited through the Dutch Lung Foundation. Each group met 3 times for 2 hours each at a 1-week interval. Data were analyzed with coding software, and patient descriptors were analyzed with nonparametric tests. The consolidated criteria for reporting qualitative research were followed when conducting the study. Results: We included 29 patients (16/29, 55% male; mean age 65 [SD 10] years) with COPD (n=14), asthma-COPD overlap (n=4), asthma (n=10), or other respiratory disease (n=1). There was a large variation in the internet experience; some patients hardly used the internet (4/29, 14%), whereas others used internet >3 times a week (23/29, 79%). In general, patients were positive about having access to a PWP, considering access to personal medical records as the most important option, though only after discussion with their physician. A medication overview was considered a useful option. We found that communication between health care professionals could be improved if patients could use the PWP to share information with their health care professionals. However, as participants were worried about the language and usability of portals, it was recommended that language should be adapted to the patient level. Another concern was that disease monitoring through Web-based questionnaire use would only be useful if the results were discussed with health care professionals. Conclusions: Participants were positive about PWPs and considered them a logical step. Today, most patients tend to be better educated and have internet access, while also being more assertive and better informed about their disease. A PWP could support these patients. Our participants also provided practical suggestions for implementation in current and future PWP developments. The next step will be to develop a portal based on these recommendations and assess whether it meets the needs of patients and health care providers. %M 30684436 %R 10.2196/formative.8822 %U http://formative.jmir.org/2018/2/e22/ %U https://doi.org/10.2196/formative.8822 %U http://www.ncbi.nlm.nih.gov/pubmed/30684436 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e24 %T The iPrevent Online Breast Cancer Risk Assessment and Risk Management Tool: Usability and Acceptability Testing %A Lo,Louisa L %A Collins,Ian M %A Bressel,Mathias %A Butow,Phyllis %A Emery,Jon %A Keogh,Louise %A Weideman,Prue %A Steel,Emma %A Hopper,John L %A Trainer,Alison H %A Mann,Gregory B %A Bickerstaffe,Adrian %A Antoniou,Antonis C %A Cuzick,Jack %A Phillips,Kelly-Anne %+ Department of Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Victoria, 8006, Australia, 61 3 85597860, Kelly.Phillips@petermac.org %K clinical decision support %K breast cancer %K BRCA1 gene %K BRCA2 gene %K risk %K preventive health %K screening %D 2018 %7 07.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: iPrevent estimates breast cancer (BC) risk and provides tailored risk management information. Objective: The objective of this study was to assess the usability and acceptability of the iPrevent prototype. Methods: Clinicians were eligible for participation in the study if they worked in primary care, breast surgery, or genetics clinics. Female patients aged 18-70 years with no personal cancer history were eligible. Clinicians were first familiarized with iPrevent using hypothetical paper-based cases and then actor scenarios; subsequently, they used iPrevent with their patients. Clinicians and patients completed the System Usability Scale (SUS) and an Acceptability questionnaire 2 weeks after using iPrevent; patients also completed measures of BC worry, anxiety, risk perception, and knowledge pre- and 2 weeks post-iPrevent. Data were summarized using descriptive statistics. Results: The SUS and Acceptability questionnaires were completed by 19 of 20 clinicians and 37 of 43 patients. Usability was above average (SUS score >68) for 68% (13/19) clinicians and 76% (28/37) patients. The amount of information provided by iPrevent was reported as “about right” by 89% (17/19) clinicians and 89% (33/37) patients and 95% (18/19) and 97% (36/37), respectively, would recommend iPrevent to others, although 53% (10/19) clinicians and 27% (10/37) patients found it too long. Exploratory analyses suggested that iPrevent could improve risk perception, decrease frequency of BC worry, and enhance BC prevention knowledge without changing state anxiety. Conclusions: The iPrevent prototype demonstrated good usability and acceptability. Because concerns about length could be an implementation barrier, data entry has been abbreviated in the publicly available version of iPrevent. %M 30684421 %R 10.2196/formative.9935 %U http://formative.jmir.org/2018/2/e24/ %U https://doi.org/10.2196/formative.9935 %U http://www.ncbi.nlm.nih.gov/pubmed/30684421 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10945 %T Barriers and Opportunities for Using Wearable Devices to Increase Physical Activity Among Veterans: Pilot Study %A Kim,Rebecca H %A Patel,Mitesh S %+ Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA,, United States, 1 2678720364, rebecca.kim@uphs.upenn.edu %K veterans %K wearable devices %K connected health device %K physical activity %K mobile phone %D 2018 %7 06.11.2018 %9 Short Paper %J JMIR Formativ Res %G English %X Background: Few studies have examined the use of wearable devices among the veteran population. Objective: The objective of this study was to evaluate veterans’ perceptions of and experiences with wearable devices and identify the potential barriers and opportunities to using such devices to increase physical activity levels in this population. Methods: Veterans able to ambulate with or without assistance completed surveys about their mobile technology use and physical activity levels. They were then given the option of using a wearable device to monitor their activity levels. Follow-up telephone interviews were conducted after 2 months. Results: A total of 16 veterans were enrolled in this study, and all of them agreed to take home and use the wearable device to monitor their activity levels. At follow-up, 91% (10/11) veterans were still using the device daily. Veterans identified both opportunities and barriers for incorporating these devices into interventions to increase physical activity. Conclusions: Veterans engaged in using wearable devices at high rates. %M 30684414 %R 10.2196/10945 %U http://formative.jmir.org/2018/2/e10945/ %U https://doi.org/10.2196/10945 %U http://www.ncbi.nlm.nih.gov/pubmed/30684414 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e11062 %T Time Series Visualizations of Mobile Phone-Based Daily Diary Reports of Stress, Physical Activity, and Diet Quality in Mostly Ethnic Minority Mothers: Feasibility Study %A Comulada,W Scott %A Swendeman,Dallas %A Rezai,Roxana %A Ramanathan,Nithya %+ Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, 10920 Wilshire Boulevard, Suite 350, Los Angeles, CA, 90024, United States, 1 3107948278, wcomulada@mednet.ucla.edu %K changepoint %K diet quality %K mobile phone %K moving average %K physical activity %K stress %K time series %D 2018 %7 05.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Health behavior patterns reported through daily diary data are important to understand and intervene upon at the individual level in N-of-1 trials and related study designs. There is often interest in relationships between multiple outcomes, such as stress and health behavior. However, analyses often utilize regressions that evaluate aggregate effects across individuals, and standard analyses target single outcomes. Objective: This paper aims to illustrate how individuals’ daily reports of stress and health behavior (time series) can be explored using visualization tools. Methods: Secondary analysis was conducted on 6 months of daily diary reports of stress and health behavior (physical activity and diet quality) from mostly ethnic minority mothers who pilot-tested a self-monitoring mobile health app. Time series with minimal missing data from 14 of the 44 mothers were analyzed. Correlations between stress and health behavior within each time series were reported as a preliminary step. Stress and health behavior time series patterns were visualized by plotting moving averages and time points where mean shifts in the data occurred (changepoints). Results: Median correlation was small and negative for associations of stress with physical activity (r=−.14) and diet quality (r=−.08). Moving averages and changepoints for stress and health behavior were aligned for some participants but not for others. A third subset of participants exhibited little variation in stress and health behavior reports. Conclusions: Median correlations in this study corroborate prior findings. In addition, time series visualizations highlighted variations in stress and health behavior across individuals and time points, which are difficult to capture through correlations and regression-based summary measures. %M 30684407 %R 10.2196/11062 %U https://formative.jmir.org/2018/2/e11062/ %U https://doi.org/10.2196/11062 %U http://www.ncbi.nlm.nih.gov/pubmed/30684407 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e11025 %T Web-Delivered Multimedia Training Materials for the Self-Collection of Dried Blood Spots: A Formative Project %A Allen,Alicia M %A Lundeen,Kim %A Murphy,Sharon E %A Spector,Logan %A Harlow,Bernard L %+ Department of Family & Community Medicine, College of Medicine, University of Arizona, Suite 300, 3950 South Country Club Road, Tucson, AZ, 85713, United States, 1 5206268157, aliciaallen@email.arizona.edu %K dried blood spot %K internet %K feasibility studies %D 2018 %7 05.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The use of dried blood spots (DBS) in biomedical research has been increasing as an objective measure for variables that are typically plagued by self-report, such as smoking status and medication adherence. The development of training materials for the self-collection of DBS that can be delivered through the Web would allow for broader use of this methodology. Objective: The objective of this study was to evaluate the acceptability and feasibility of the self-collection of DBS using newly developed multimedia training materials that were delivered through the Web. We also aimed to assess the usability of the collected DBS samples. Methods: We recruited participants through Facebook advertising for two distinct studies. The first study evaluated the acceptability of our newly developed DBS training materials, while the second assessed the implementation of this protocol into a larger Web-based study. Results: In the first study, participants (N=115) were aged, on average, 26.1 (SD 6.4) years. Training materials were acceptable (113/115, 98.2%, of participants were willing to collect DBS again) and produced usable samples (110/115, 95.7%, collected DBS were usable). In the second study, response rate was 25.0% (41/164), with responders being significantly younger than nonresponders (20.3 [SD 0.2] vs 22.0 [SD 0.4]; P<.001), and 92% (31/41) of collected DBS samples were usable by the laboratory. Conclusions: Overall, while the protocol is acceptable, feasible, and produced usable samples, additional work is needed to improve response rates. %M 30684406 %R 10.2196/11025 %U http://formative.jmir.org/2018/2/e11025/ %U https://doi.org/10.2196/11025 %U http://www.ncbi.nlm.nih.gov/pubmed/30684406 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e23 %T Using Cocreation in the Process of Designing a Smartphone App for Adolescents and Young Adults With Cancer: Prototype Development Study %A Elsbernd,Abbey %A Hjerming,Maiken %A Visler,Camilla %A Hjalgrim,Lisa Lyngsie %A Niemann,Carsten Utoft %A Boisen,Kirsten Arntz %A Jakobsen,Jens %A Pappot,Helle %+ Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, Copenhagen, 2100, Denmark, 45 3545 8403, helle.pappot@regionh.dk %K adolescent and young adult %K cancer %K cocreation %K mHealth %K oncology %D 2018 %7 01.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Adolescent and young adult (AYA) oncology and hematology is a developing field of medicine, focusing on a population that faces many challenges throughout medical treatment and beyond. Mobile health (mHealth) interventions provide exciting new opportunities for improvement of health-related quality of life (HRQoL) in AYAs with cancer. Many smartphone apps are currently available for AYAs with cancer; however, for AYAs with cancer, very few apps have been designed with direct input from AYAs themselves or have demonstrated their effectiveness and benefit. Objective: The objective of this project was to develop the prototype of a smartphone app for AYAs with cancer through the process of cocreation, with the active input of AYAs who have received treatment for cancer directly impacting content and design. Methods: Patients were recruited from a population of Danish AYAs who had received treatment for cancer between the ages of 15 and 29 years. The cocreation process was completed over the course of 3 workshops and intermittent ad hoc meetings, where the recruited AYAs worked in coordination with 1 nurse, 1 doctor, and 2 representatives from a digital agency and app developer. During each workshop, participants prioritized their goals for the app. After new app content was developed, feedback was requested from the participants, and changes were made accordingly. This iterative process continued until consensus on final product features and design were achieved. Health care professionals provided minimal input and primarily performed observational roles in the workshops, with direct interaction limited to introducing the project and explaining measurement features of the app in development. Results: Three key features to be included in the prototype app were identified from the cocreation workshops: (1) a community forum; (2) an information library; and (3) a symptom and side-effect tracking tool. Bright, warm colors were selected for the app by the participating AYAs. The final prototype will be launched for pilot testing and implementation testing in February of 2018. Conclusions: The process of cocreation is a user-involved process that can create an end product that is useful and customized for the target population. This process, as such, is a beneficial process to utilize when addressing the specific needs of AYAs with cancer. The results of the here described app prototype will be evaluated in more detail in the near future. However, this description of the cocreation process in app development can be utilized for the creation of other mHealth interventions. %M 30684439 %R 10.2196/formative.9842 %U http://formative.jmir.org/2018/2/e23/ %U https://doi.org/10.2196/formative.9842 %U http://www.ncbi.nlm.nih.gov/pubmed/30684439 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e21 %T A Web-Based Interactive Tool to Reduce Childhood Obesity Risk in Urban Minority Youth: Usability Testing Study %A Verdaguer,Sandra %A Mateo,Katrina F %A Wyka,Katarzyna %A Dennis-Tiwary,Tracy A %A Leung,May May %+ School of Urban Public Health, Hunter College, The City University of New York, 2180 Third Avenue, New York, NY, 10035, United States, 1 212 396 7774, maymay.leung@hunter.cuny.edu %K usability testing %K interactive technology %K mHealth, childhood obesity %K minority %K health nutrition %K health education %D 2018 %7 01.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Childhood obesity is a serious public health issue among minority youth in the United States. Technology-enhanced approaches can be effective for promoting healthy behavior change. Objective: The purpose of this study was to test the usability of prototypes of a Web-based interactive tool promoting healthy dietary behaviors to reduce childhood obesity risk in urban minority youth. The Web-based tool comprised a manga-style comic with interactive features (eg, sound effects, clickable pop-ups), tailored messaging, and goal setting, and was optimized for use on tablet devices. Methods: Latino and black/African American children ages 9 to 13 years were recruited to participate in two rounds of usability testing. A modified think-aloud method was utilized. Self-reported surveys and field notes were collected. Audio recordings and field notes from usability testing sessions were systematically reviewed by extracting and coding user feedback as either positive comments or usability or negative issues. The quantitative data from self-reported questionnaires were analyzed using descriptive statistics. Results: Twelve children (four female; eight black/African American) with a mean age of 10.92 (SD 1.16) years participated. Testing highlighted overall positive experiences with the Web-based interactive tool, especially related to storyline, sound effects, and color schemes. Specific usability issues were classified into six themes: appearance, content, special effects, storyline, terminology, and navigation. Changes to the Web-based tool after round 1 included adding a navigation guide, making clickable icons more visible, improving graphic designs, and fixing programming errors. In round 2 of testing (after modifications to the Web-based tool were incorporated), many of the usability issues that were identified in round 1 did not emerge. Conclusions: Results of testing will inform further development and finalization of the tool, which will be tested using a two-group pilot randomized study, with the goal of reducing childhood obesity risk in minority, low-income youth. %M 30684417 %R 10.2196/formative.9747 %U http://formative.jmir.org/2018/2/e21/ %U https://doi.org/10.2196/formative.9747 %U http://www.ncbi.nlm.nih.gov/pubmed/30684417 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10025 %T Linking Podcasts With Social Media to Promote Community Health and Medical Research: Feasibility Study %A Balls-Berry,Joyce %A Sinicrope,Pamela %A Valdez Soto,Miguel %A Brockman,Tabetha %A Bock,Martha %A Patten,Christi %+ Center for Clinical and Translational Science, Mayo Clinic, 200 First Street SW, Rochester, MN,, United States, 1 507 538 3755, ballsberry.joyce@mayo.edu %K biomedical research %K community health %K community and patient engagement in research %K podcast %K social media %D 2018 %7 24.10.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Linking podcasts with social media is a strategy to promote and disseminate health and health research information to the community without constraints of time, weather, and geography. Objective: To describe the process of creating a podcast library and promoting it on social media as a strategy for disseminating health and biomedical research topics to the community. Methods: We used a community and patient engagement in research approach for developing a process to use podcasts for dissemination of health and health research information. We have reported the aspects of audience reach, impressions, and engagement on social media through the number of downloads, shares, and reactions posted on SoundCloud, Twitter, and Facebook, among others. Results: In collaboration with our local community partner, we produced 45 podcasts focused on topics selected from a community health needs assessment with input from health researchers. Episodes lasted about 22 minutes and presented health-related projects, community events, and community resources, with most featured guests from Olmsted County (24/45, 53%). Health research was the most frequently discussed topic. Between February 2016 and June 2017, episodes were played 1843 times on SoundCloud and reached 1702 users on our Facebook page. Conclusions: This study demonstrated the process and feasibility of creating a content library of podcasts for disseminating health- and research-related information. Further examination is needed to determine the best methods to develop a sustainable social media plan that will further enhance dissemination (audience reach), knowledge acquisition, and communication of health topics. %M 30684430 %R 10.2196/10025 %U http://formative.jmir.org/2018/2/e10025/ %U https://doi.org/10.2196/10025 %U http://www.ncbi.nlm.nih.gov/pubmed/30684430 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10257 %T Effects of Cold Stimulation on Cardiac-Vagal Activation in Healthy Participants: Randomized Controlled Trial %A Jungmann,Manuela %A Vencatachellum,Shervin %A Van Ryckeghem,Dimitri %A Vögele,Claus %+ Institute for Health and Behaviour, Faculty of Language and Literature, Humanities, Arts and Education, University of Luxembourg, Campus Belval, Maison des Sciences Humaines, 11, Porte des Sciences, Esch-sur-Alzette, 4366, Luxembourg, 352 4666449755, manuela.jungmann@uni.lu %K cold stimulation %K heart rate reduction %K lateral neck region %K diving reflex %K stress reduction %K wearable electronic devices %K thermode-based stimulation %K acute stress %K technology for stress relief %K vagus nerve stimulation %K psychological stress %D 2018 %7 09.10.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The experience of psychological stress has not yet been adequately tackled with digital technology by catering to healthy individuals who wish to reduce their acute stress levels. For the design of digitally mediated solutions, physiological mechanisms need to be investigated that have the potential to induce relaxation with the help of technology. Research has shown that physiological mechanisms embodied in the face and neck regions are effective for diminishing stress-related symptoms. Our study expands on these areas with the design for a wearable in mind. As this study charts new territory in research, it also is a first evaluation of the viability for a wearables concept to reduce stress. Objective: The objectives of this study were to assess whether (1) heart rate variability would increase and (2) heart rate would decrease during cold stimulation using a thermode device compared with a (nonstimulated) control condition. We expected effects in particular in the neck and cheek regions and less in the forearm area. Methods: The study was a fully randomized, within-participant design. Volunteer participants were seated in a laboratory chair and tested with cold stimulation on the right side of the body. A thermode was placed on the neck, cheek, and forearm. We recorded and subsequently analyzed participants’ electrocardiogram. The cold stimulation was applied in 16-second intervals over 4 trials per testing location. The control condition proceeded exactly like the cold condition, except we manipulated the temperature variable to remain at the baseline temperature. We measured heart rate as interbeat intervals in milliseconds and analyzed root mean square of successive differences to index heart rate variability. We analyzed data using a repeated-measures ANOVA (analysis of variance) approach with 2 repeated-measures factors: body location (neck, cheek, forearm) and condition (cold, control). Results: Data analysis of 61 participants (after exclusion of outliers) showed a main effect and an interaction effect for body location and for condition, for both heart rate and heart rate variability. The results demonstrate a pattern of cardiovascular reactivity to cold stimulation, suggesting an increase in cardiac-vagal activation. The effect was significant for cold stimulation in the lateral neck area. Conclusions: The results confirmed our main hypothesis that cold stimulation at the lateral neck region would result in higher heart rate variability and lower heart rate than in the control condition. This sets the stage for further investigations of stress reduction potential in the neck region by developing a wearable prototype that can be used for cold application. Future studies should include a stress condition, test for a range of temperatures and durations, and collect self-report data on perceived stress levels to advance findings. %M 30684416 %R 10.2196/10257 %U http://formative.jmir.org/2018/2/e10257/ %U https://doi.org/10.2196/10257 %U http://www.ncbi.nlm.nih.gov/pubmed/30684416 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e20 %T A Locally Developed Electronic Health Platform in Uganda: Development and Implementation of Stre@mline %A Liang,Li %A Wiens,Matthew O %A Lubega,Phaisal %A Spillman,Ian %A Mugisha,Samuel %+ Innovation Streams Limited, Plot 76/78 High Street, Mbarara La Grand Mall Room L2-03, Mbarara, PO Box 1340, Uganda, 256 704899935, samuel.gisha@gmail.com %K electronic health record %K locally developed technology %K appropriate technology %K eHealth in low-resource settings %D 2018 %7 24.9.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Electronic health records (EHRs) are especially important in low-resource settings due to their potential to address unique challenges such as a high number of patients requiring long-term treatments who are lost to follow-up, the frequent shortages of essential drugs, poor maintenance and storage of records, and inefficient clinical triaging. However, there is a lack of affordable and practical EHR solutions. Stre@mline is an EHR platform that has been locally developed by Ugandan clinicians and engineers in Southwestern Uganda. It is tailored to the specific context and needs of low-resource hospitals. It operates without internet access, incorporates locally relevant standards and key patient safety features, has a medication inventory management component, has local technical support available, and is economically sustainable without funding from international donors. Stre@mline is currently used by over 60,000 patients at 2 hospitals, with plans to expand across Uganda. Objective: The purpose of this article is to describe the key opportunities and challenges in EHR development in sub-Saharan Africa and to summarize the development and implementation of a “Made-for-Africa” EHR, Stre@mline, and how it has led to improved care for over 60,000 vulnerable patients in a rural region of Southwestern Uganda. Methods: A quantitative user survey consisting of a set of 33 questions on usability and performance was conducted at Kisiizi Hospital. Users responded to each question through a Likert scale with the values of strongly disagree, disagree, agree, and strongly agree. Through purposive sampling, 30 users were identified and 28 users completed the survey. Results: We found that users were generally very satisfied with the ease of use of Stre@mline, with 96% (27/28) finding it easy to learn and 100% (28/28) finding it easy to use. Users found that Stre@mline was helpful in improving both clinical efficiency and enhancing patient care. Conclusions: The partnership of local clinicians and developers is crucial to the design and adoption of user-centered technologies tailored to the specific needs of low-resource settings. The EHR described here could serve as a model for the development of future technologies suitable for developing countries. %M 30684419 %R 10.2196/formative.9658 %U http://formative.jmir.org/2018/2/e20/ %U https://doi.org/10.2196/formative.9658 %U http://www.ncbi.nlm.nih.gov/pubmed/30684419 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10055 %T Adolescent Preferences and Design Recommendations for an Asthma Self-Management App: Mixed-Methods Study %A Roberts,Courtney %A Sage,Adam %A Geryk,Lorie %A Sleath,Betsy %A Carpenter,Delesha %+ Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 301 Pharmacy Lane, Chapel Hill, NC, 27599, United States, 1 919 843 2278, carrinde@live.unc.edu %K asthma %K mHealth %K mobile app %K patient engagement %K self-management %K usability %D 2018 %7 13.09.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Approximately 10% of adolescents in the United States have asthma. Adolescents widely use apps on mobile phones and tablet technology for social networking and gaming purposes. Given the increase in recreational app use among adolescents, leveraging apps to support adolescent asthma disease management seems warranted. However, little empirical research has influenced asthma app development; adolescent users are seldom involved in the app design process. Objective: The aim of this mixed-methods study was to assess adolescent preferences and design recommendations for an asthma self-management app. Methods: A total of 20 adolescents with persistent asthma (aged 12-16 years) provided feedback on two asthma self-management apps during in-person semistructured interviews following their regularly scheduled asthma clinic visit and via telephone 1 week later. Interviews were audiorecorded, transcribed verbatim, analyzed using SPSS v24, and coded thematically using MAXQDA 11. Results: Regarding esthetics, app layout and perceived visual simplicity were important to facilitate initial app use. Adolescents were more likely to continually engage with apps that were deemed useful and met their informational needs. Adolescents also desired app features that fit within their existing paradigm or schema and included familiar components (eg, medication alerts that appear and sound like FaceTime notifications and games modeled after Quiz Up and Minecraft), as well as the ability to customize app components. They also suggested that apps include other features, such as an air quality tracker and voice command. Conclusions: Adolescents desire specific app characteristics including customization and tailoring to meet their asthma informational needs. Involving adolescents in early stages of app development is likely to result in an asthma app that meets their self-management needs and design preferences and ultimately the adoption and maintenance of positive asthma self-management behaviors. %M 30684424 %R 10.2196/10055 %U http://formative.jmir.org/2018/2/e10055/ %U https://doi.org/10.2196/10055 %U http://www.ncbi.nlm.nih.gov/pubmed/30684424 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e16 %T Improving Transitions of Care for Young Adults With Congenital Heart Disease: Mobile App Development Using Formative Research %A Lopez,Keila N %A O'Connor,Michael %A King,Jason %A Alexander,James %A Challman,Melissa %A Lovick,Donna K %A Goodly,Nicole %A Smith,Amelia %A Fawcett,Elliott %A Mulligan,Courtney %A Thompson,Debbe %A Fordis,Michael %+ Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, 6621 Fannin Street, MC 19-345, Houston, TX, 77030, United States, 1 832 826 5600, knlopez@bcm.edu %K adolescent health %K chronic disease %K transitions of care %K health disparities %K mobile health %K mHealth %K patient empowerment %K patient involvement %K self-efficacy %K user-centered design %D 2018 %7 11.09.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Congenital heart diseases (CHDs) are the most common type of birth defects. Improvements in CHD care have led to approximately 1.4 million survivors reaching adulthood. Successful transition and transfer from pediatric to adult care is crucial. Unfortunately, less than 30% of adolescents with CHD successfully transition to adult care; this number is lower for minority and lower socioeconomic status populations. Few CHD programs exist to facilitate successful transition. Objective: The goal of our study was to describe the formative research used to develop a prototype mobile app to facilitate transition to adult care for adolescents with CHD. Methods: A literature search about best practices in transition medicine for CHD was conducted to inform app development. Formative research with a diverse group of CHD adolescents and their parents was conducted to determine gaps and needs for CHD transition to adult care. As part of the interview, surveys assessing transition readiness and CHD knowledge were completed. Two adolescent CHD expert panels were convened to inform educational content and app design. Results: The literature review revealed 113 articles, of which 38 were studies on transition programs and attitudes and 3 identified best practices in transition specific to CHD. A total of 402 adolescents aged 15 to 22 years (median 16 years) participated in semistructured interviews. The group was racially and ethnically diverse (12.6% [51/402] African American and 37.8% [152/402] Latino) and 42.0% (169/402) female; 36.3% (146/402) received public insurance. Most adolescents (313/402, 76.7%) had moderate or severe CHD complexity and reported minimal CHD understanding (79.0% [275/348] of those aged 15 to 17 years and 61.1% [33/54] of those aged 18 to 22 years). Average initial transition readiness score was 50.9/100, meaning that transition readiness training was recommended. When participants with moderate to severe CHD (313/402, 77.9%) were asked about technology use, 94.2% (295/313) reported having access to a mobile phone. Interviews with parents revealed limited interactions with the pediatric cardiologist about transition-related topics: 79.4% (331/417) reported no discussions regarding future family planning, and 55.2% (230/417) reported the adolescent had not been screened for mental health concerns (depression, anxiety). Further, 66.4% (277/417) reported not understanding how health care changes as adolescents become adults. Adolescents in the expert panels (2 groups of 3 adolescents each) expressed interest in a CHD-specific tailored app consisting of quick access to specific educational questions (eg, “Can I exercise?”), a CHD story-blog forum, a mentorship platform, a question and answer space, and a checklist to facilitate transition. They expressed interest in using the app to schedule CHD clinic appointments and receive medication reminders. Based on this data, a prototype mobile app was created to assist in adolescent CHD transition. Conclusions: Formative research revealed that most adolescents with CHD had access to mobile phones, were not prepared for transition to adult care, and were interested in an app to facilitate transition to adult CHD care. Understanding adolescent and parent needs, interests, and concerns helped in the development of a mobile app with a broader, tailored approach for adolescents with CHD. %R 10.2196/formative.9963 %U http://formative.jmir.org/2018/2/e16/ %U https://doi.org/10.2196/formative.9963 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e18 %T Adapting a Behavioral Weight Loss Intervention for Delivery via Facebook: A Pilot Series Among Low-Income Postpartum Women %A Silfee,Valerie J %A Lopez-Cepero,Andrea %A Lemon,Stephenie C %A Estabrook,Barbara %A Nguyen,Oanh %A Wang,Monica L %A Rosal,Milagros C %+ Division of Preventive and Behavioral Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, United States, 1 508 856 3173, Milagros.Rosal@umassmed.edu %K Facebook %K health disparities %K postpartum women %K social media %K weight loss %D 2018 %7 10.09.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Efforts to translate evidence-based weight loss interventions, such as the Diabetes Prevention Program (DPP), to low-income postpartum women have resulted in poor intervention attendance and high attrition. Strategies that improve engagement and retention in this population are needed to maximize the reach of evidence-based weight loss interventions. Objective: The objective of this study was to adapt a DPP-based weight loss intervention (Fresh Start) for Facebook delivery and to evaluate its feasibility among low-income postpartum women. Methods: This study comprised 3 single-group pilot studies where feasibility outcomes iteratively informed changes from one pilot to the next. We paralleled the in-person program for Facebook delivery by translating the protocol to a content library of Facebook posts with additional posts from lifestyle coaches. Low-income postpartum women were recruited from Women, Infants, and Children (WIC) clinics in Worcester, Massachusetts. Participants were enrolled into a 16-week weight loss intervention delivered via Facebook. During the first 8 weeks, Facebook intervention posts were delivered 2 times per day, with additional posts from coaches aiming to stimulate interaction among participants or respond to participants’ questions and challenges. For the following 8 weeks, posts were delivered once per day without additional coaching. Feasibility outcomes were engagement (defined by number of likes, comments, and posts measured throughout intervention delivery), acceptability, and retention (survey at follow-up and assessment completion rate, respectively). Changes in weight were also assessed at baseline and follow-up. Results: Pilot 1 had a retention rate of 89% (24/27), and on average, 62% (17/27) of women actively engaged with the group each week during the 8-week coached phase. Mean weight loss was 2.6 (SD 8.64) pounds, and 79% (19/27) would recommend the program to a friend. Pilot 2 had a retention rate of 83% (20/24), and on average, 55% (13/24) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 2.5 (SD 9.23) pounds, and 80% (16/24) would recommend the program to a friend. Pilot 3 had a retention rate of 88% (14/16), and on average, 67% (11/16) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 7.0 (SD 11.6) pounds, and 100% (16/16) would recommend the program to a friend. Conclusions: Our findings demonstrated that a Facebook-delivered intervention was acceptable and could be feasibly delivered to low-income postpartum women. Future research is needed to evaluate the efficacy of a Facebook-delivered weight loss intervention. %M 30684423 %R 10.2196/formative.9597 %U http://formative.jmir.org/2018/2/e18/ %U https://doi.org/10.2196/formative.9597 %U http://www.ncbi.nlm.nih.gov/pubmed/30684423 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e19 %T A Stress Management App Intervention for Cancer Survivors: Design, Development, and Usability Testing %A Børøsund,Elin %A Mirkovic,Jelena %A Clark,Matthew M %A Ehlers,Shawna L %A Andrykowski,Michael A %A Bergland,Anne %A Westeng,Marianne %A Solberg Nes,Lise %+ Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hospital, PO Box 4950 Nydalen, Oslo, 0424, Norway, 47 92667262, elin.borosund@rr-research.no %K stress management %K mindfulness %K cancer %K eHealth %K mHealth %K mobile apps %K development %K usability %K user-centered design %K mobile phones %D 2018 %7 06.09.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Distress is prevalent in cancer survivors. Stress management interventions can reduce distress and improve quality of life for cancer patients, but many people with cancer are unfortunately not offered or able to attend such in-person stress management interventions. Objective: The objective of this study was to develop an evidence-based stress management intervention for patients living with cancer that can be delivered electronically with wide reach and dissemination. This paper describes the design and development process of a technology-based stress management intervention for cancer survivors, including the exploration phase, intervention content development, iterative software development (including design, development, and formative evaluation of low- and high-level prototypes), and security and privacy considerations. Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=48). In the exploration phase, identifying needs and requirements for the intervention, 28 participants gave input, including male and female cancer survivors (n=11) representing a wide age range (31-81 years) and cancer diagnoses, healthcare providers (n=8) including psychosocial oncology experts, and eHealth experts (n=9) including information technology design and developers. To ensure user involvement in each phase various user-centered design and service design methods were included, such as interviews, usability testing, and think aloud processes. Overall, participants were involved usability testing in the software development and formative evaluation phase, including cancer survivors (n=6), healthy volunteers (n=7), health care providers (n=2), and eHealth experts (n=5). Intervention content was developed by stress management experts based on well-known cognitive behavioral stress management strategies and adjusted to electronic format through multiple iterations with stakeholders. Privacy and security issues were considered throughout. Results: The design and development process identified a variety of stakeholder requirements. Cancer survivors preferred stress management through a mobile app rather than through a personal computer (PC) and identified usefulness, easy access, user friendliness, use of easily understandable language, and many brief sections rather than longer ones as important components of the intervention. These requirements were also supported by recommendations from health care providers and eHealth experts. The final intervention was named StressProffen and the hospital Privacy and Security Protection Committee was part of the final intervention approval to also ensure anchoring in the hospital organization. Conclusions: Interventions, even evidence-based, have little impact if not actively used. This study illustrates how user-centered design and service design can be applied to identify and incorporate essential stakeholder aspects in the entire design and development process. In combination with evidence-based concepts, this process facilitated development of a stress management intervention truly designed for the end users, in this case, cancer survivors. Trial Registration: ClinicalTrials.gov NCT02939612; https://clinicaltrials.gov/ct2/show/NCT02939612 (Archived at WebCite at http://www.webcitation.org/71l9HcfcB) %M 30684438 %R 10.2196/formative.9954 %U http://formative.jmir.org/2018/2/e19/ %U https://doi.org/10.2196/formative.9954 %U http://www.ncbi.nlm.nih.gov/pubmed/30684438 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e11138 %T Conversation Within a Facebook Smoking Cessation Intervention Trial For Young Adults (Tobacco Status Project): Qualitative Analysis %A McKelvey,Karma %A Ramo,Danielle %+ Weill Institute for Neurosciences, Department of Psychiatry, University of California San Francisco, 401 Parnassus Avenue, San Francisco, CA, 94143, United States, 1 4154767695, danielle.ramo@ucsf.edu %K Facebook %K intervention %K qualitative analysis %K smoking cessation %K social media %K young adults %D 2018 %7 04.09.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Smoking cessation interventions delivered through social media have the potential to engage young people in behavior change. Objective: The aim of this study was to describe participant-posted messages in a Facebook smoking cessation intervention for young adults to discern support for behavior change. Methods: We qualitatively analyzed data from the treatment arm of a randomized trial testing the efficacy of the Tobacco Status Project Facebook intervention. Young adults (N=138) aged 18-25 years (female: 81/138, 58.7%; white: 101/138, 73.2%; mean age 21 years) were recruited using Facebook and placed into one of the 15 secret Facebook groups based on readiness-to-quit smoking. Messages posted to groups for 90 consecutive days were tailored to readiness-to-quit: Not Ready (46/138, 33.3%), Thinking (66/138, 47.8%), and Getting Ready (26/138, 18.8%). Groups were randomized to receive up to US $90 for posting or no incentive. Two independent coders conducted open coding of user posts. We considered content by readiness-to-quit group and incentive condition. Results: There were 4 dominant themes across all groups: coping skills, friends and family, motivation to quit, and benefits of quitting. The dominant themes in Not Ready groups were friends and family (incentive) and motivation to quit (no incentive), whereas coping skills was the dominant theme in Thinking and Getting Ready groups. The expression of themes varied by readiness-to-quit group but not by incentive condition. Conclusions: Intervention messages tailored to readiness-to-quit appear useful in eliciting the desired responses from young adult smokers, with limited influence by monetary incentive. Trial Registration: ClinicalTrials.gov NCT02207036; https://clinicaltrials.gov/ct2/show/NCT02207036 (Archived by WebCite at http://www.webcitation.org/722XAEAAz) %M 30684432 %R 10.2196/11138 %U http://formative.jmir.org/2018/2/e11138/ %U https://doi.org/10.2196/11138 %U http://www.ncbi.nlm.nih.gov/pubmed/30684432 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e173 %T Assessing the Cross-Cultural Adaptation and Translation of a Text-Based Mobile Smoking Cessation Program in Samoa (TXTTaofiTapaa): Pilot Study %A McCool,Judith %A Tanielu,Helen %A Umali,Elaine %A Whittaker,Robyn %+ Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1141, New Zealand, 64 09 373 7599 ext 82372, j.mccool@auckland.ac.nz %K mHealth %K mobile phone %K Pacific %K Samoa %K tobacco cessation %K text messages %D 2018 %7 31.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Samoa faces a persistently high prevalence of adult tobacco use and few existing cessation support services. Mobile phones are ubiquitous and generally affordable. Objective: This study aimed to adopt a text message (short message service, SMS) smoking cessation program designed in New Zealand (stop smoking with mobile phones, STOMP) for use in Samoa to assist national objectives in reducing the tobacco use. Methods: Using focus groups with smokers and ex-smokers, we explored the context for tobacco use and preferences for SMS text messages. Postintervention focus groups were held after participants received SMS text messages for 1 week. Frequent face-to-face meetings with the primary partner (Ministry of Health Samoa) and key stakeholders contributed to the adaptation process. Participatory feedback and collaboration from stakeholders became an integral part of the cultural adaptation and translation of the program. Furthermore, detailed document analyses were included as part of the formal evaluation of the initiative to explore the core determinants of success in adapting the program to the Samoan cultural context. Results: The SMS text messages evolved remarkably following an iterative process of consultation, in situ testing, revision, and retesting to arrive at an acceptable country-specific version of the mobile smoking cessation program. The SMS text messages retained in the final set were consistent with the theory of behavioral change but reflected both linguistic and cultural nuances appropriate for Samoa. Adapting messages required simultaneous multilevel processes, including complex high-level engagement, between the team and the stakeholders, along with crafting the precise content for (character limited) messages. Conclusions: Receiving cessation support messages through a mobile phone is promising and appears to be an acceptable and accessible mode of delivery for tobacco cessation, particularly in the absence of alternative support. Adapting a text-based program in Samoa requires fastidious attention to the nuances of culture, language, and sociopolitical structures in the country. %M 30170994 %R 10.2196/mhealth.9033 %U http://mhealth.jmir.org/2018/8/e173/ %U https://doi.org/10.2196/mhealth.9033 %U http://www.ncbi.nlm.nih.gov/pubmed/30170994 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e17 %T Assessing the Feasibility and Pre-Post Impact Evaluation of the Beta (Test) Version of the BeUpstanding Champion Toolkit in Reducing Workplace Sitting: Pilot Study %A Healy,Genevieve Nissa %A Eakin,Elizabeth G %A Winkler,Elisabeth AH %A Hadgraft,Nyssa %A Dunstan,David W %A Gilson,Nicholas D %A Goode,Ana D %+ School of Public Health, The University of Queensland, 266 Herston Road, Herston, Brisbane, 4006, Australia, 61 733655528, g.healy@uq.edu.au %K BeUpstanding Champion Toolkit %K implementation %K physical activity %K sedentary %K workplace sitting %D 2018 %7 28.08.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The Web-based, evidence-informed BeUpstanding Champion Toolkit was developed to provide employers (via a “train-the-champion approach”) with resources and support to help in reducing prolonged sitting in their own desk-based workplace. As part of a five-phase research-to-dissemination process, this study reports on the evaluation of the beta (test) version of this toolkit (Phase 2). Objective: The objective of our study was to evaluate (1) the implementation of the toolkit by workplace champions and (2) the impact of the toolkit on sitting (primary outcome), standing, and moving; use of activity-promoting strategies; knowledge and attitudes; and indicators of health and work performance. Methods: An implementation study using a pre-post design was conducted in 7 desk-based workplaces in Australia (September 2015 to May 2016), with work teams (one per workplace) purposively recruited to ensure representation across a range of sectors (white- or blue-collar), organizational sizes (small or medium or large), and locations (metropolitan or regional). All staff within participating teams were invited to participate in the relevant toolkit activities. Implementation outcomes (time commitment required by champions and toolkit activities completed) were collected from each champion via telephone interviews. Changes in impact outcomes, measured via a Web-based questionnaire completed by employees at baseline and 3 months postimplementation, were assessed using mixed models, correcting for clustering. Results: Champions reported a 30-60 minutes per week time commitment to the toolkit activities. All teams formed a wellbeing committee and sent the staff surveys at both time points; most champions held a staff consultation workshop (6/7), identified team-level strategies within that workshop (5/7), used the communication resources provided within the toolkit (emails, posters; 6/7), and completed the action plan (5/7). In total, 52% (315 of ≈600) employees participated in at least one survey and 97 (16%) participated in both. At follow-up, there was a significant (P<.05) reduction in self-reported workplace sitting time compared to baseline (−6.3%, 95% CI −10.1 to −2.5; n=85) equating to ≈30 minutes per workday. Significant benefits were also observed for the use of activity-promoting strategies, with small, nonsignificant changes observed for knowledge and attitudes and indicators of health and work performance. Conclusions: The beta version of the BeUpstanding Champion Toolkit was feasible to implement and effective in reducing self-reported workplace sitting across a broad range of desk-based workplaces. The next phase (Phase 3) will build on these findings to optimize the toolkit for wider-scale implementation and longer term evaluation. %M 30684420 %R 10.2196/formative.9343 %U http://formative.jmir.org/2018/2/e17/ %U https://doi.org/10.2196/formative.9343 %U http://www.ncbi.nlm.nih.gov/pubmed/30684420 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 3 %P e54 %T A Mobile App–Based Intervention for Depression: End-User and Expert Usability Testing Study %A Fuller-Tyszkiewicz,Matthew %A Richardson,Ben %A Klein,Britt %A Skouteris,Helen %A Christensen,Helen %A Austin,David %A Castle,David %A Mihalopoulos,Cathrine %A O'Donnell,Renee %A Arulkadacham,Lilani %A Shatte,Adrian %A Ware,Anna %+ School of Psychology, Deakin University, 1 Gheringhap Street, Geelong, 3220, Australia, 61 392517344, matthewf@deakin.edu.au %K depression %K eHealth %K mHealth %K young adult %D 2018 %7 23.08.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Despite the growing number of mental health apps available for smartphones, the perceived usability of these apps from the perspectives of end users or health care experts has rarely been reported. This information is vital, particularly for self-guided mHealth interventions, as perceptions of navigability and quality of content are likely to impact participant engagement and treatment compliance. Objective: The aim of this study was to conduct a usability evaluation of a personalized, self-guided, app-based intervention for depression. Methods: Participants were administered the System Usability Scale and open-ended questions as part of a semistructured interview. There were 15 participants equally divided into 3 groups: (1) individuals with clinical depression who were the target audience for the app, (2) mental health professionals, and (3) researchers who specialize in the area of eHealth interventions and/or depression research. Results: The end-user group rated the app highly, both in quantitative and qualitative assessments. The 2 expert groups highlighted the self-monitoring features and range of established psychological treatment options (such as behavioral activation and cognitive restructuring) but had concerns that the amount and layout of content may be difficult for end users to navigate in a self-directed fashion. The end-user data did not confirm these concerns. Conclusions: Encouraging participant engagement via self-monitoring and feedback, as well as personalized messaging, may be a viable way to maintain participation in self-guided interventions. Further evaluation is necessary to determine whether levels of engagement with these features enhance treatment effects. %M 30139722 %R 10.2196/mental.9445 %U http://mental.jmir.org/2018/3/e54/ %U https://doi.org/10.2196/mental.9445 %U http://www.ncbi.nlm.nih.gov/pubmed/30139722 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10125 %T Game Plan: Development of a Web App Designed to Help Men Who Have Sex With Men Reduce Their HIV Risk and Alcohol Use %A Wray,Tyler %A Kahler,Christopher W %A Simpanen,Erik M %A Operario,Don %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main Street, Box G-S121-5, Providence, RI,, United States, 1 401 863 6659, tyler_wray@brown.edu %K alcohol %K HIV risk %K internet %K intervention %D 2018 %7 23.08.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Men who have sex with men (MSM) are at high risk for HIV, and alcohol use is a major risk factor for HIV infection. Internet-facilitated brief interventions have been shown to reduce alcohol use and HIV-risk behavior in other at-risk populations, but have so far incorporated limited content and have not been tested among MSM. Objective: This manuscript describes Game Plan, an interactive, tablet-optimized web application designed to help heavy drinking, high-risk MSM consider reducing their alcohol use and sexual risk behavior. In this paper, we discuss the rationale, goals, and flow for each of Game Plan’s components, which were modelled after common in-person and web-based brief motivational interventions for these behaviors. Methods: The development of Game Plan was informed by a thorough user-focused design research process that included (1) audits of existing interventions, (2) focus groups with stakeholders and (3) intended users (high-risk, heavy drinking MSM), and (4) usability testing. The aesthetic, features, and content of the app were designed iteratively throughout this process Results: The fully-functional Game Plan app provides (1) specific and personal feedback to users about their level of risk, (2) exercises to help prompt users to reflect on whether their current behavior aligns with other important life goals and values, and for those open to change, (3) exercises to help users understand factors that contribute to risk, and (4) a change planning module. In general, this flow was constructed to roughly align with the two phases described in early accounts of motivational interviewing (MI): (1) Content intended to elicit intrinsic motivation for change, and when/if sufficient motivation is present, (2) content intended to translate that motivation into specific goals and plans for change. This sequence first focuses on the user’s HIV risk behavior, followed by their alcohol use and the connection between the two. The app’s overall aesthetic (eg, branding, color palettes, icons/graphics) and its onboarding sequence was also designed to align with the “spirit” of MI by conveying respect for autonomy, open-mindedness (ie, avoiding judgment), and empathy. Conclusions: Should future research support its efficacy in facilitating behavior change, Game Plan could represent a wide-reaching and scalable tool that is well-suited for use in settings where delivering evidence-based, in-person interventions would be difficult or cost-prohibitive. %M 30684415 %R 10.2196/10125 %U http://formative.jmir.org/2018/2/e10125/ %U https://doi.org/10.2196/10125 %U http://www.ncbi.nlm.nih.gov/pubmed/30684415 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 8 %P e172 %T A Mobile App (iBeni) With a Neuropsychological Basis for Cognitive Stimulation for Elderly Adults: Pilot and Validation Study %A Martínez-Alcalá,Claudia I %A Rosales-Lagarde,Alejandra %A Hernández-Alonso,Esmeralda %A Melchor-Agustin,Roberto %A Rodriguez-Torres,Erika E %A Itzá-Ortiz,Benjamín A %+ Consejo Nacional de Ciencia y Tecnología, Av Insurgentes Sur 1582, Col Crédito Constructor, Del Benito Juárez, Ciudad de México, 03940, Mexico, 52 (771) 71 72 000 ext 4332, c_isabel_alcala@hotmail.com %K mobile application %K cognitive stimulation %K cognitive impairment %K older adults %K neuropsychological evaluation. %D 2018 %7 21.08.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Cognitive impairment is considered one of the most feared chronic conditions among the older adult population since its incidence is approximately twice more frequent than that of dementia. In Mexico, no studies or reports of older adults using technology for cognitive interventions have been published, given that institutions usually frame cognitive stimulation tasks in paper and pencil (ie, in the traditional manner). Objective: The objective of this study was to create and analyze the effect, viability, and impact of a mobile app for cognitive stimulation implemented among a group of elderly adults (over 60 years of age) from the state of Hidalgo in Mexico. Methods: This study was a nonprobabilistic pilot trial using convenience sampling. An intervention was implemented among a group of 22 older adults between 60 and 80 years of age over 12 weeks. Half of the older adults were stimulated with the mobile app (experimental group) and the other half followed the traditional paper and pencil training (control group). Assessments with the Mini-Mental State Examination (MMSE) and the Neuropsi, a neuropsychological test validated in Mexico, were done before and after both cognitive stimulations. Results: According to the analyzed data, 6/11 (55%) participants from the experimental group obtained better results in their cognitive skills, and 5 (45%) of the adults maintained their score, given that the participants were able to execute the exercises repetitively. Meanwhile, for the control group, only 3/11 (27%) participants obtained better results in the postevaluation. Significant values for results of the MMSE were obtained in the postevaluation for the experimental group compared to the control group, while results did not show significant differences in the Neuropsi. Regarding the validation of the app, all the participants evaluated its pertinence positively. Conclusions: The intervention data show that the experimental group obtained better results in the postevaluation given that the participants were able to execute the exercises repetitively. The control group could not accomplish this since they had to respond on the manual and no further attempts were provided. However, both groups increased their score in the neuropsychological evaluations. This suggests that a longer and more frequent intervention is required. Registered Report Identifier: RR1-10.2196/9603 %M 30131319 %R 10.2196/resprot.9603 %U http://www.researchprotocols.org/2018/8/e172/ %U https://doi.org/10.2196/resprot.9603 %U http://www.ncbi.nlm.nih.gov/pubmed/30131319 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e15 %T Electronic Swallowing Intervention Package to Support Swallowing Function in Patients With Head and Neck Cancer: Development and Feasibility Study %A Cowie,Julie %A Boa,Sally %A King,Emma %A Wells,Mary %A Cairns,David %+ Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, Govan Mbeki Building, Cowcaddens Road, Glasgow, G4 0BA, United Kingdom, 44 141 331 8100, julie.cowie@gcu.ac.uk %K head and neck cancer %K eHealth %K self-management %K mHealth %K chemoradiotherapy %K mobile phones %D 2018 %7 17.08.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Many patients undergoing treatment for head and neck cancer (HNC) experience significant swallowing difficulties, and there is some evidence that swallowing exercises may improve outcomes, including quality of life. This feasibility study developed an evidence-based, practical Swallowing Intervention Package (SiP) for patients undergoing chemoradiotherapy (CRT) for HNC. As part of the study, an electronic version of SiP (e-SiP) was concurrently developed to support patients to self-manage during treatment. This paper reports on the e-SiP component of this work. Objective: The objective of our study was to develop and conduct a preliminary evaluation of an electronic support system (e-SiP) for patients undergoing CRT for HNC. Methods: The study was conducted using a recognized mHealth development and evaluation framework and involved health professionals and patients who were undergoing CRT for HNC. The scoping stage of e-SiP development investigated the potential usefulness of the app, exploring how e-SiP would look and feel and what content would be appropriate to provide. Patient and carer focus groups and a health professionals’ consensus day were used as means of data gathering around potential e-SiP content. A repeat focus group looked at an outline version of e-SiP and informed the next stage of its development with regard to refining the requirements for the tool. This was followed by further development and a testing stage of e-SiP that involved the coding of a prototype, which was then evaluated using a series of steering group meetings, semistructured interviews with both patients and health care professionals, and analysis of e-SiP log data. Results: Feedback from focus groups and health professional interviews was very positive, and it was felt e-SiP use would support and encourage patients in conducting their swallowing exercises. However, of the 10 patients who were offered e-SiP, only 2 opted to use it. For these patients, the aspects of the e-SiP app were considered useful, in particular, the ease of keeping a diary of exercises performed. Interviews with users and nonusers suggested significant barriers to its use. Most significantly, the lack of flexibility of the platform on which e-SiP could be accessed appeared a dominant factor in deterring e-SiP use. Conclusions: The results suggest that further research needs to be conducted around the implementation of e-SiP. This involves evaluating how e-SiP can be better integrated into usual care and through patient training and staff engagement, can be perceived as a beneficial tool to help support patients in conducting swallowing exercises. %R 10.2196/formative.9703 %U http://formative.jmir.org/2018/2/e15/ %U https://doi.org/10.2196/formative.9703 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10411 %T Utilizing a Prototype Patient-Controlled Electronic Health Record in Germany: Qualitative Analysis of User-Reported Perceptions and Perspectives %A Poss-Doering,Regina %A Kunz,Aline %A Pohlmann,Sabrina %A Hofmann,Helene %A Kiel,Marion %A Winkler,Eva C %A Ose,Dominik %A Szecsenyi,Joachim %+ Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, Tower West, 4th Floor, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 6221 56 ext 38643, regina.poss-doering@med.uni-heidelberg.de %K personal patient-controlled electronic health record %K eHealth %K nationwide implementation %K continuity of care %D 2018 %7 03.08.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Personal electronic health records (PHR) are considered instrumental in improving health care quality and efficiency, enhancing communication between all parties involved and strengthening the patient’s role. Technical architectures, data privacy, and applicability issues have been discussed for many years. Nevertheless, nationwide implementation of a PHR is still pending in Germany despite legal regulations provided by the eHealth Act passed in 2015. Within the information technology for patient-oriented care project funded by the Federal Ministry of Education and Research (2012-2017), a Web-based personal electronic health record prototype (PEPA) was developed enabling patient-controlled information exchange across different care settings. Gastrointestinal cancer patients and general practitioners utilized PEPA during a 3-month trial period. Both patients and physicians authorized by them could view PEPA content online and upload or download files. Objective: This paper aims to outline findings of the posttrial qualitative study carried out to evaluate user-reported experiences, perceptions, and perspectives, focusing on their interpretation of PEPA beyond technical usability and views on a future nationwide implementation. Methods: Data were collected through semistructured guide-based interviews with 11 patients and 3 physicians (N=14). Participants were asked to share experiences, views of perceived implications, and perspectives towards nationwide implementation. Further data were generated through free-text fields in a subsequent study-specific patient questionnaire and researcher’s notes. Data were pseudonymized, audiotaped, and transcribed verbatim. Content analysis was performed through the Framework Analysis approach. All qualitative data were systemized by using MAXQDA Analytics PRO 12 (Rel.12.3.1). Additionally, participant characteristics were analyzed descriptively using IBM SPSS Statistics Version 24. Results: Users interpreted PEPA as a central medium containing digital chronological health-related documentation that simplifies information sharing across care settings. While patients consider the implementation of PEPA in Germany in the near future, physicians are more hesitant. Both groups believe in PEPA’s concept, but share awareness of concerns about data privacy and older or impaired people’s abilities to manage online records. Patients perceive benefits for involvement in treatment processes and continuity of care but worry about financing and the implementation of functionally reduced versions. Physicians consider integration into primary systems critical for interoperability but anticipate technical challenges, as well as resistance from older patients and colleagues. They omit clear positioning regarding PEPA’s potential incremental value for health care organizations or the provider-patient relationship. Conclusions: Digitalization in German health care will continue to bring change, both organizational and in the physician-patient relationship. Patients endorse and expect a nationwide PEPA implementation, anticipating various benefits. Decision makers and providers need to contribute to closing modernization gaps by committing to new concepts and by invigorating transformed roles. %M 30684411 %R 10.2196/10411 %U http://formative.jmir.org/2018/2/e10411/ %U https://doi.org/10.2196/10411 %U http://www.ncbi.nlm.nih.gov/pubmed/30684411 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e14 %T Web-Based Tailored Intervention to Support Optimal Medication Adherence Among Kidney Transplant Recipients: Pilot Parallel-Group Randomized Controlled Trial %A Côté,José %A Fortin,Marie-Chantal %A Auger,Patricia %A Rouleau,Geneviève %A Dubois,Sylvie %A Boudreau,Nathalie %A Vaillant,Isabelle %A Gélinas-Lemay,Élisabeth %+ Research Centre of the Centre Hospitalier de l’Université de Montréal, 850 St-Denis, Tour St-Antoine, Door S01-128, Montreal, QC, H2X 0A9, Canada, 1 514 890 8000 ext 15536, jose.cote@umontreal.ca %K medication adherence %K transplant recipient %K self-management %K nursing %K Web-based tailored intervention %K randomized controlled trial %D 2018 %7 19.07.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Optimal immunosuppressive medication adherence is essential to graft survival. Transplant-TAVIE is a Web-based tailored intervention developed to promote this adherence. Objective: The objective of our study was to evaluate the Transplant-TAVIE intervention’s acceptability, feasibility, and preliminary efficacy. Methods: In a pilot, parallel-group, randomized controlled trial, we randomly assigned a convenience sample of 70 kidney transplant patients on immunosuppressive medication either to an experimental group (Transplant-TAVIE) or to a control group (existing websites). Kidney transplant recipients had to be older than 18 years, be taking immunosuppressant medication, and have access to the internet to participate in this study. Transplant-TAVIE was composed of three interactive Web-based sessions hosted by a virtual nurse. We documented user appreciation of and exposure to the intervention. Furthermore, we assessed medication adherence, medication self-efficacy, intake-related skills, and medication side effects at baseline and 3 and 6 months later. Analyses of variance were used to assess intergroup differences over time. Results: After baseline questionnaire completion, participants were randomly assigned either to Transplant-TAVIE (n=35) or to the websites (n=35) group. All participants had received their kidney graft <1 year to 32 years earlier (mean 6.8 years). Of the experimental group, 54% (19/35) completed the sessions of Transplant-TAVIE. Users found the intervention to be acceptable—33% were extremely satisfied (6/18), 39% were very satisfied (7/18), and 28% were satisfied (5/18). At baseline and over time, both experimental and control groups reported high medication adherence, high medication self-efficacy, and frequent use of skills related to medication intake. No intergroup differences emerged over time. Conclusions: The results of this study support the feasibility and acceptability of Transplant-TAVIE. It could constitute an accessible adjunct in support of existing specialized services. %M 30684400 %R 10.2196/formative.9707 %U http://formative.jmir.org/2018/2/e14/ %U https://doi.org/10.2196/formative.9707 %U http://www.ncbi.nlm.nih.gov/pubmed/30684400 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 7 %P e165 %T The Development of Complex Digital Health Solutions: Formative Evaluation Combining Different Methodologies %A Lee,Anne %A Sandvei,Marianne %A Asmussen,Hans Christian %A Skougaard,Marie %A Macdonald,Joanne %A Zavada,Jakub %A Bliddal,Henning %A Taylor,Peter C %A Gudbergsen,Henrik %+ Centre for Innovative Medical Technology, Odense University Hospital, Kloevervanget 8, Odense, 5000, Denmark, 45 21656406, anne.lee@rsyd.dk %K eHealth %K telemedicine %K stakeholder participation %K formative evaluation %K participatory design %K intervention theories %D 2018 %7 16.07.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The development of digital health solutions for current health care settings requires an understanding of the complexities of the health care system, organizational setting, and stakeholder groups and of the underlying interplay between stakeholders and the technology. The digital health solution was founded on the basis of an information and communication technology platform and point-of-care devices enabling home-based monitoring of disease progression and treatment outcome for patients with rheumatoid arthritis (RA). Objective: The aim of this paper is to describe and discuss the applicability of an iterative evaluation process in guiding the development of a digital health solution as a technical and organizational entity in three different health care systems. Methods: The formative evaluation comprised the methodologies of contextual understanding, participatory design, and feasibility studies and included patients, healthcare professionals, and hardware and software developers. In total, the evaluation involved 45 patients and 25 health care professionals at 3 clinical sites in Europe. Results: The formative evaluation served as ongoing and relevant input to the development process of the digital health solution. Through initial field studies key stakeholder groups were identified and knowledge obtained about the different health care systems, the professional competencies involved in routine RA treatment, the clinics’ working procedures, and the use of communication technologies. A theory-based stakeholder evaluation achieved a multifaceted picture of the ideas and assumptions held by stakeholder groups at the three clinical sites, which also represented the diversity of three different language zones and cultures. Experiences and suggestions from the patients and health care professionals were sought through participatory design processes and real-life testing and actively used for adjusting the visual, conceptual, and practical design of the solution. The learnings captured through these activities aided in forming the solution and in developing a common understanding of the overall vision and aim of this solution. During this process, the 3 participating sites learned from each other’s feed-back with the ensuing multicultural inspiration. Moreover, these efforts also enabled the consortium to identify a ‘tipping point’ during a pilot study, revealing serious challenges and a need for further development of the solution. We achieved valuable learning during the evaluation activities, and the remaining challenges have been clarified more extensively than a single-site development would have discovered. The further obstacles have been defined as has the need to resolve these before designing and conducting a real-life clinical test to assess the outcome from a digital health solution for RA treatment. Conclusions: A formative evaluation process with ongoing involvement of stakeholder groups from 3 different cultures and countries have helped to inform and influence the development of a novel digital health solution, and provided constructive input and feedback enabling the consortium to control the development process. %M 30012548 %R 10.2196/resprot.9521 %U http://www.researchprotocols.org/2018/7/e165/ %U https://doi.org/10.2196/resprot.9521 %U http://www.ncbi.nlm.nih.gov/pubmed/30012548 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 3 %N 3 %P e10431 %T Design and Development of a Context-Aware Knowledge-Based Module for Identifying Relevant Information and Information Gaps in Patients With Type 1 Diabetes Self-Collected Health Data %A Giordanengo,Alain %A Øzturk,Pinar %A Hansen,Anne Helen %A Årsand,Eirik %A Grøttland,Astrid %A Hartvigsen,Gunnar %+ Norwegian Centre for E-health Research, University Hospital of North Norway, Postboks 35, Tromsø, 9038, Norway, 47 91715718, alain.giordanengo@ehealthresearch.no %K context aware %K knowledge-based system %K diabetes %K self-collected health data %K information gaps %D 2018 %7 11.07.2018 %9 Original Paper %J JMIR Diabetes %G English %X Background: Patients with diabetes use an increasing number of self-management tools in their daily life. However, health institutions rarely use the data generated by these services mainly due to (1) the lack of data reliability, and (2) medical workers spending too much time extracting relevant information from the vast amount of data produced. This work is part of the FullFlow project, which focuses on self-collected health data sharing directly between patients’ tools and EHRs. Objective: The main objective is to design and implement a prototype for extracting relevant information and documenting information gaps from self-collected health data by patients with type 1 diabetes using a context-aware approach. The module should permit (1) clinicians to assess the reliability of the data and to identify issues to discuss with their patients, and (2) patients to understand the implication their lifestyle has on their disease. Methods: The identification of context and the design of the system relied on (1) 2 workshops in which the main author participated, 1 patient with type 1 diabetes, and 1 clinician, and (2) a co-design session involving 5 patients with type 1 diabetes and 4 clinicians including 2 endocrinologists and 2 diabetes nurses. The software implementation followed a hybrid agile and waterfall approach. The testing relied on load, and black and white box methods. Results: We created a context-aware knowledge-based module able to (1) detect potential errors, and information gaps from the self-collected health data, (2) pinpoint relevant data and potential causes of noticeable medical events, and (3) recommend actions to follow to improve the reliability of the data issues and medical issues to be discussed with clinicians. The module uses a reasoning engine following a hypothesize-and-test strategy built on a knowledge base and using contextual information. The knowledge base contains hypotheses, rules, and plans we defined with the input of medical experts. We identified a large set of contextual information: emotional state (eg, preferences, mood) of patients and medical workers, their relationship, their metadata (eg, age, medical specialty), the time and location of usage of the system, patient-collected data (eg, blood glucose, basal-bolus insulin), patients’ goals and medical standards (eg, insulin sensitivity factor, in range values). Demonstrating the usage of the system revealed that (1) participants perceived the system as useful and relevant for consultation, and (2) the system uses less than 30 milliseconds to treat new cases. Conclusions: Using a knowledge-based system to identify anomalies concerning the reliability of patients’ self-collected health data to provide information on potential information gaps and to propose relevant medical subjects to discuss or actions to follow could ease the introduction of self-collected health data into consultation. Combining this reasoning engine and the system of the FullFlow project could improve the diagnostic process in health care. %M 30291097 %R 10.2196/10431 %U http://diabetes.jmir.org/2018/3/e10431/ %U https://doi.org/10.2196/10431 %U http://www.ncbi.nlm.nih.gov/pubmed/30291097 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e13 %T A Text Messaging Intervention (Txt4HappyKids) to Promote Fruit and Vegetable Intake Among Families With Young Children: Pilot Study %A Power,Julianne Mary %A Bersamin,Andrea %+ Center for Alaska Native Health Research, Institute of Arctic Biology, University of Alaska Fairbanks, 902 N Koyukuk Drive, PO Box 757000, Fairbanks, AK, 99775, United States, 1 907 474 6129, abersamin@alaska.edu %K fruits and vegetables %K nutrition education %K nutrition intervention %K young children %K text messaging %D 2018 %7 06.07.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Increasing fruit and vegetable intake among low-income populations, especially children, is a priority for United States federal food assistance programs. With over 49 million federal food assistance program recipients, cost-effective and efficient methods are needed to effectively deliver nutrition education to such a large population. Objective: The objective of our study was to examine the preliminary efficacy and acceptability of a text messaging intervention, Txt4HappyKids, to promote fruit and vegetable intake among families with young children. Methods: The intervention was evaluated using a pre-post study design. Parents (N=72) in Alaska were recruited from venues that serve a predominantly low-income population to participate in an 11-week intervention based on social cognitive theory. Parents received two texts per week promoting child fruit and vegetable intake. Behaviors, self-efficacy, and attitudes related to fruit and vegetable intake were measured at baseline and postintervention. Perceived changes in behaviors and open-ended feedback were also collected postintervention. Results: Of all participants, 67.3% (72/107) completed the intervention. We found no changes in behavior (P=.26), self-efficacy (P=.43), or attitudes (P=.35) related to fruit and vegetable intake from pre- to postintervention. Completers reported that since their participation in Txt4HappyKids, 92% (66/72) served more fruits and vegetables to their child because they thought fruits and vegetables were beneficial, 86% (62/72) tried to follow a healthier diet, 85% (61/72) tried different ways of preparing fruits and vegetables, and 81% (58/72) were more aware of the foods their child consumes. Additionally, 79% (57/72) of completers thought that Txt4HappyKids was credible, 71% (51/72) found texts useful, and 82% (59/72) would recommend it to a friend. Conclusions: A text messaging intervention was not sufficient to increase fruit and vegetable intake among families with young children. However, parents felt positively impacted by Txt4HappyKids and were receptive to nutrition information, despite the absence of face-to-face contact. High satisfaction among completers indicates that text messaging may be an acceptable complement to budget-constrained nutrition programs. These findings are an important first step in developing larger multi-level interventions utilizing mobile technology; however, a more rigorous evaluation of the Txt4HappyKids intervention is warranted. %M 30684412 %R 10.2196/formative.8544 %U http://formative.jmir.org/2018/2/e13/ %U https://doi.org/10.2196/formative.8544 %U http://www.ncbi.nlm.nih.gov/pubmed/30684412 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 6 %P e10457 %T An Online Hand Exercise Intervention for Adults With Rheumatoid Arthritis (mySARAH): Design, Development, and Usability Testing %A Srikesavan,Cynthia %A Williamson,Esther %A Cranston,Tim %A Hunter,John %A Adams,Jo %A Lamb,Sarah E %+ Rehabilitation Research in Oxford, Nuffield Department of Orthopedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford, OX3 7LD, United Kingdom, 44 01865737907, cynthia.srikesavan@ndorms.ox.ac.uk %K rheumatoid arthritis %K hand joints %K exercise training %K web-based %D 2018 %7 27.06.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) program is a tailored, progressive 12-week exercise program for people with hand problems due to rheumatoid arthritis. The program was shown to be clinically and cost-effective in a large clinical trial and is recommended by the UK National Institute for Health and Care Excellence (NICE) guidelines for rheumatoid arthritis in adults. Objective: We have developed an online version of the SARAH program (mySARAH) to make the SARAH program widely accessible to people with rheumatoid arthritis. The purposes of this study were to develop mySARAH and to evaluate and address its usability issues. Methods: We developed mySARAH using a three-step process and gaining feedback from patient contributors. After initial development, mySARAH was tested in two iterative usability cycles in nine participants using a simplified think-aloud protocol and self-reported questionnaires. We also evaluated if participants executed the SARAH exercises correctly after watching the exercise videos included on the website. Results: A preliminary version of mySARAH consisting of six sessions over a 12-week period and delivered via text, exercise videos, images, exercise plan form, exercise calendar, and links to additional information on rheumatoid arthritis was developed. Five participants (1 male; 4 females; median age 64 years) and four participants (four females; median age 64.5 years) took part in the first and second usability testing cycles respectively. Usability issues identified from Cycle 1 such as having a navigation tutorial video and individualised feedback on pain levels were addressed prior to Cycle 2. The need for more instructions to complete the mySARAH patient forms was identified in Cycle 2 and was rectified. Self-reports from both cycles indicated that participants found the program useful and easy to use and were confident in performing the SARAH exercises themselves. Eight of the nine participants correctly demonstrated all the exercises. Conclusions: mySARAH is the first online hand exercise intervention for people with rheumatoid arthritis. We actively involved target users in the development and usability evaluation and ensured mySARAH met their needs and preferences. %M 29950288 %R 10.2196/10457 %U http://www.jmir.org/2018/6/e10457/ %U https://doi.org/10.2196/10457 %U http://www.ncbi.nlm.nih.gov/pubmed/29950288 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e12 %T Investigating Associations Between Changes in Mobile Phone Use and Emotions Using the Experience Sampling Method: Pilot Study %A Roggeveen,Suzanne %A van Os,Jim %A Bemelmans,Kelly %A van Poll,Mikal %A Lousberg,Richel %+ Department of Psychiatry and Psychology, Maastricht University, Vijverdalseweg 1, Maastricht,, Netherlands, 31 43 3884111, s.roggeveen@maastrichtuniversity.nl %K mobile phone %K experience sampling method %K emotions %K affect %K concentration %D 2018 %7 18.06.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The use of mobile phones has become, especially for young people, an integrated part of everyday life. Using the experience sampling method (ESM) may provide further insight on the association between mobile phone use and mental health. Objective: The objective of this study was to examine associations between mobile phone use and subtle changes in mental state. Methods: The ESM-based PsyMate app was installed on the mobile phones of 2 healthy 20-year-old participants. Over a period of 3 months, participants rated their mental states at 10 semirandom moments in the flow of daily life. Each assessment included present state emotions, environmental circumstances, and phone use. Results: Multilevel regression analyses indicated that an increase in mobile phone use was associated with a small increase in negative affect (particularly feeling bored and feeling lonely; P<.001) and small decreases in positive affect (P=.002) and concentration (P=.001). Treating the data as 2 separate N=1 studies revealed that the association with negative affect was present in both participants, whereas the associations with positive affect and concentration were evident in only 1 of the 2 participants. Conclusions: This pilot study suggests that mobile phone use may be associated with person-specific and group-level changes in emotional state. A larger study is required to study these associations, possible causality, and factors driving underlying heterogeneity in the pattern of associations. Trial registration: ClinicalTrials.gov NCT03221985; https://clinicaltrials.gov/ct2/show/NCT03221985 (archived by WebCite at http://www.webcitation.org/6zJnp61Wj) %M 30684428 %R 10.2196/formative.8499 %U http://formative.jmir.org/2018/1/e12/ %U https://doi.org/10.2196/formative.8499 %U http://www.ncbi.nlm.nih.gov/pubmed/30684428 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 6 %P e154 %T Development of a Tailored Intervention With Computerized Clinical Decision Support to Improve Quality of Care for Patients With Knee Osteoarthritis: Multi-Method Study %A Van de Velde,Stijn %A Kortteisto,Tiina %A Spitaels,David %A Jamtvedt,Gro %A Roshanov,Pavel %A Kunnamo,Ilkka %A Aertgeerts,Bert %A Vandvik,Per Olav %A Flottorp,Signe %+ Centre for Informed Health Choices, Norwegian Institute of Public Health, Postboks 4404 Nydalen, Oslo, 0403, Norway, 47 46 40 04 75, stijn.vandevelde@med.kuleuven.be %K decision support systems, clinical %K practice guidelines as topic %K guideline adherence %K evidence-based medicine %K osteoarthritis, knee %K focus groups %D 2018 %7 11.06.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Clinical practice patterns greatly diverge from evidence-based recommendations to manage knee osteoarthritis conservatively before resorting to surgery. Objective: This study aimed to tailor a guideline-based computerized decision support (CDS) intervention that facilitates the conservative management of knee osteoarthritis. Methods: Experts with backgrounds in clinical medicine, research, implementation, or health informatics suggested the most important recommendations for implementation, how to develop an implementation strategy, and how to form the CDS algorithms. In 6 focus group sessions, 8 general practitioners and 22 patients from Norway, Belgium, and Finland discussed the suggested CDS intervention and identified factors that would be most critical for the success of the intervention. The focus group moderators used the GUideline Implementation with DEcision Support checklist, which we developed to support consideration of CDS success factors. Results: The experts prioritized 9 out of 22 recommendations for implementation. We formed the concept for 6 CDS algorithms to support implementation of these recommendations. The focus group suggested 59 unique factors that could affect the success of the presented CDS intervention. Five factors (out of the 59) were prioritized by focus group participants in every country, including the perceived potential to address the information needs of both patients and general practitioners; the credibility of CDS information; the timing of CDS for patients; and the need for personal dialogue about CDS between the general practitioner and the patient. Conclusions: The focus group participants supported the CDS intervention as a tool to improve the quality of care for patients with knee osteoarthritis through shared, evidence-based decision making. We aim to develop and implement the CDS based on these study results. Future research should address optimal ways to (1) provide patient-directed CDS, (2) enable more patient-specific CDS within the context of patient complexity, and (3) maintain user engagement with CDS over time. %M 29891466 %R 10.2196/resprot.9927 %U http://www.researchprotocols.org/2018/6/e154/ %U https://doi.org/10.2196/resprot.9927 %U http://www.ncbi.nlm.nih.gov/pubmed/29891466 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 6 %P e10525 %T A Digital Decision Support Tool to Enhance Decisional Capacity for Clinical Trial Consent: Design and Development %A Furberg,Robert D %A Ortiz,Alexa M %A Moultrie,Rebecca R %A Raspa,Melissa %A Wheeler,Anne C %A McCormack,Lauren A %A Bailey Jr,Donald B %+ Digital Health and Clinical Informatics, RTI International, 3040 E Cornwallis Road, Research Triangle Park, NC, 27709-2194, United States, 1 919 316 3726, rfurberg@rti.org %K decision support %K informed consent %K digital health %K intellectual disability %K fragile X syndrome %K telemedicine %D 2018 %7 06.06.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Challenges in the clinical and research consent process indicate the need to develop tailored, supportive interventions for all individuals, especially those with limited decisional capacity. We developed a tool to enhance shared decision making and the decisional capacity for individuals with fragile X syndrome engaged in the informed consent process for a clinical trial. Objective: We describe the design and development process of a tablet-based decision support tool. Methods: Our development process for the decision support tool employed a user-centered, feature-driven design approach. We began with an environmental scan to catalog relevant mobile apps, and we conducted interviews with people with a diagnosis of fragile X syndrome and clinicians at fragile X syndrome clinics. To develop content for the decision support tool, we extracted key concepts and elements from a real clinical trial consent form and rewrote it using plain-language principles. Results: We used iterative testing to continuously evaluate and revise the decision support tool content. The tool was finalized in 2016 and contained a series of vignettes, quiz questions, and a sorting activity. A randomized controlled trial was then conducted to compare the efficacy of the decision support tool with a standard verbal presentation of material that mimicked typical informed consent practice. Conclusions: The informed consent process is primed to leverage digital health resources that promote increased understanding and engagement of research participants in the consent and research process. The process and experiences we describe may provide a model for other digital health design and development initiatives seeking to create more interactive and accessible decision support resources. Trial Registration: ClinicalTrials.gov NCT02465931; https://www.clinicaltrials.gov/ct2/show/NCT02465931 (Archived by WebCite at http://www.webcitation.org/6zx2KY9YW) %R 10.2196/10525 %U http://www.researchprotocols.org/2018/6/e10525/ %U https://doi.org/10.2196/10525 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e10774 %T Developing Technology to Mobilize Personal Strengths in People with Chronic Illness: Positive Codesign Approach %A Mirkovic,Jelena %A Jessen,Stian %A Kristjansdottir,Olöf Birna %A Krogseth,Tonje %A Koricho,Absera Teshome %A Ruland,Cornelia M %+ Center for Shared Decision Making and Collaborative Care Research, Division of Medicine, Oslo University Hostipal, Box 4950 Nydalen, Oslo, 0424, Norway, 47 46343869, Jelena.Mirkovic@rr-research.no %K patient personal strengths %K participatory design %K codesign %K appreciative inquiry %K service design %K positive computing %K positive technology %K chronic disease %K eHealth %K mHealth %K patient requirements %K patient participation %D 2018 %7 05.06.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Emerging research from psychology and the bio-behavioral sciences recognizes the importance of supporting patients to mobilize their personal strengths to live well with chronic illness. Positive technology and positive computing could be used as underlying design approaches to guide design and development of new technology-based interventions for this user group that support mobilizing their personal strengths. Objective: A codesigning workshop was organized with the aim to explore user requirements and ideas for how technology can be used to help people with chronic illness activate their personal strengths in managing their everyday challenges. Methods: Thirty-five participants from diverse backgrounds (patients, health care providers, designers, software developers, and researchers) participated. The workshop combined principles of (1) participatory and service design to enable meaningful participation and collaboration of different stakeholders and (2) an appreciative inquiry methodology to shift participants’ attention to positive traits, values, and aspects that are meaningful and life-giving and stimulate participants’ creativity, engagement, and collaboration. Utilizing these principles, participants were engaged in group activities to develop ideas for strengths-supportive tools. Each group consisted of 3-8 participants with different backgrounds. All group work was analysed using thematic analyses. Results: Participants were highly engaged in all activities and reported a wide variety of requirements and ideas, including more than 150 personal strength examples, more than 100 everyday challenges that could be addressed by using personal strengths, and a wide range of functionality requirements (eg, social support, strength awareness and reflection, and coping strategies). 6 concepts for strength-supportive tools were created. These included the following: a mobile app to support a person to store, reflect on, and mobilize one’s strengths (Strengths treasure chest app); “empathy glasses” enabling a person to see a situation from another person’s perspective (Empathy Simulator); and a mobile app allowing a person to receive supportive messages from close people in a safe user-controlled environment (Cheering squad app). Suggested design elements for making the tools engaging included: metaphors (eg, trees, treasure island), visualization techniques (eg, dashboards, color coding), and multimedia (eg, graphics). Maintaining a positive focus throughout the tool was an important requirement, especially for feedback and framing of content. Conclusions: Combining participatory, service design, and appreciative inquiry methods were highly useful to engage participants in creating innovative ideas. Building on peoples’ core values and positive experiences empowered the participants to expand their horizons from addressing problems and symptoms, which is a very common approach in health care today, to focusing on their capacities and that which is possible, despite their chronic illness. The ideas and user requirements, combined with insights from relevant theories (eg, positive technology, self-management) and evidence from the related literature, are critical to guide the development of future more personalized and strengths-focused self-management tools. %M 30684404 %R 10.2196/10774 %U http://formative.jmir.org/2018/1/e10774/ %U https://doi.org/10.2196/10774 %U http://www.ncbi.nlm.nih.gov/pubmed/30684404 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e11 %T Feasibility of a Proactive Text Messaging Intervention for Smokers in Community Health Centers: Pilot Study %A Kruse,Gina %A Kelley,Jennifer HK %A Chase,Karen %A Rigotti,Nancy A %+ Division of General Internal Medicine, Massachusetts General Hospital, 100 Cambridge Street, 16th Floor, Boston, MA, 02114, United States, 1 6177243157, gkruse@partners.org %K smoking cessation %K primary health care %K text messaging %D 2018 %7 31.05.2018 %9 Short Paper %J JMIR Formativ Res %G English %X Background: Few smokers receive evidence-based cessation services during primary care visits. Objective: We aimed to assess the feasibility of a proactive text messaging program for primary care patients who smoke. Methods: We used electronic health records to identify smokers who had a mobile phone number listed from two community health centers in Massachusetts. Between March 2014 and June 2015, patients were screened by their primary care physician and then sent a proactive text message inviting them to enroll by texting back. Patients who opted in were asked about their readiness to quit. The text message program included messages from the QuitNowTXT library and novel content for smokers who were not ready to quit. Results: Among 949 eligible smokers, 88 (9.3%) enrolled after receiving a single proactive text message. Compared with those who did not enroll, enrollees were more often female (54/88, 61% vs 413/861, 48.0%, P=.02), but otherwise did not differ in age, race, insurance status, or comorbidities. In all, 28% (19/67) of enrollees reported they were not ready to quit in the next 30 days, 61% (41/67) were ready to quit, and 11% (7/67) already quit. The median time in the program was 9 days (interquartile range 2-32 days). Of current smokers, 25% (15/60) sent one or more keyword requests to the server. These did not differ by readiness to quit. Conclusions: A proactively delivered text messaging program targeting primary care patients who smoke was feasible and engaged both smokers ready to quit and those not ready to quit. This method shows promise as part of a population health model for addressing tobacco use outside of the primary care office. %R 10.2196/formative.9608 %U http://formative.jmir.org/2018/1/e11/ %U https://doi.org/10.2196/formative.9608 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e10 %T A Multimedia Support Skills Intervention for Female Partners of Male Smokeless Tobacco Users: Use and Perceived Acceptability %A Akers,Laura %A Andrews,Judy A %A Gordon,Judith S %+ Oregon Research Institute, 1776 Millrace Drive, Eugene, OR, 97403, United States, 1 541 484 2123, lauraa@ori.org %K tobacco cessation %K social support %K multimedia %K website design %K website development %K website use assessment %K usability testing %D 2018 %7 28.05.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: UCare is a new multimedia (website+booklet) intervention for women who want their male partner to quit their use of smokeless tobacco. The intervention is based on research showing that perceived partner responsiveness to social support is highest when the supporter conveys respect, understanding, and caring in their actions. The website included both didactic and interactive features, with optional video components, and special activities to help women develop empathy for nicotine addiction. The booklet reinforced the website content, encouraged women to use the website, and served both as a physical reminder of the intervention and a convenient way to share the information with her partner. Objective: The objective of this study was to describe the utilization and acceptability of a multimedia intervention among women seeking to support their partner in quitting smokeless tobacco. Lessons learned with respect to design considerations for online interventions are also summarized. Methods: We present the evaluation of the intervention components’ use and usefulness in a randomized trial. Results: In the randomized clinical trial, more than 250,000 visits were made to the website in a 2-year period, with the vast majority from mobile devices. Of the 552 women randomized to receive the intervention, 96.9% (535/552) visited the website at least once, and 30.8% (170/552) completed the core website component, “The Basics.” About half of the women (287/552) used the interactive “Take Notes” feature, and 37% (204/552) used the checklists. Few women used the post-Basics features. At 6 weeks, 40.7% (116/285) reported reading the printed and mailed booklet. Website and booklet use were uncorrelated. User ratings for the website and booklet were positive overall. Conclusions: Intervention website designers should consider that many users will access the program only once or twice, and many will not complete it. It is also important to distinguish between core and supplemental features and to consider whether the primary purpose is training or support. Furthermore, printed materials still have value. Trial Registration: ClinicalTrials.gov NCT01885221; https://clinicaltrials.gov/ct2/show/NCT01885221 (Archived by WebCite at http://www.webcitation.org/6zdIgGGtx) %R 10.2196/formative.9948 %U http://formative.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/formative.9948 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e9 %T Developing a Self-Administered Decision Aid for Fecal Immunochemical Test–Based Colorectal Cancer Screening Tailored to Citizens With Lower Educational Attainment: Qualitative Study %A Gabel,Pernille %A Kirkegaard,Pia %A Larsen,Mette Bach %A Edwards,Adrian %A Andersen,Berit %+ Department of Public Health Programmes, Randers Regional Hospital, Central Denmark Region, Skovlyvej 15, Randers NØ, DK-8930, Denmark, 45 78420185, pergab@rm.dk %K colorectal neoplasms %K mass screening %K decision support techniques %K socioeconomic factors %K qualitative research %D 2018 %7 22.05.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Citizens with lower educational attainments (EA) take up colorectal cancer screening to a lesser degree, and more seldom read and understand conventional screening information than citizens with average EAs. The information needs of citizens with lower EA are diverse, however, with preferences ranging from wanting clear recommendations to seeking detailed information about screening. Decision aids have been developed to support citizens with lower EA in making informed decisions about colorectal cancer screening participation, but none embrace diverse information needs. Objective: The aim of this study was to develop a self-administered decision aid for participation in fecal immunochemical test–based colorectal cancer screening. The decision aid should be tailored to citizens with lower EA and should embrace diverse information needs. Methods: The Web-based decision aid was developed according to an international development framework, with specific steps for designing, alpha testing, peer reviewing, and beta testing the decision aid. In the design phase, a prototype of the decision aid was developed based on previous studies about the information needs of lower EA citizens and the International Patient Decision Aid Standards guidelines. Alpha testing was conducted using focus group interviews and email correspondence. Peer review was conducted using email correspondence. Both tests included both lower EA citizens and health care professionals. The beta testing was conducted using telephone interviews with citizens with lower EA. Data were analyzed using thematic analysis. Results: The developed decision aid presented information in steps, allowing citizens to read as much or as little as wanted. Values clarification questions were included after each section of information, and answers were summarized in a “choice-indicator” on the last page, guiding the citizens toward a decision about screening participation. Statistics were presented in both natural frequencies, absolute risk formats and graphically. The citizens easily and intuitively navigated around the final version of the decision aid and stated that they felt encouraged to think about the benefits and harms of colorectal cancer screening without being overloaded with information. They found the decision aid easy to understand and the text of suitable length. The health care professionals agreed with the citizens on most parts; however, concerns were raised about the length and readability of the text. Conclusions: We have developed a self-administered decision aid presenting information in steps. We involved both citizens and health care professionals to target the decision aid for citizens with lower EA. This decision aid represents a new way of communicating detailed information and may be able to enhance informed choices about colorectal cancer screening participation among citizens with lower EA. %M 30684402 %R 10.2196/formative.9696 %U http://formative.jmir.org/2018/1/e9/ %U https://doi.org/10.2196/formative.9696 %U http://www.ncbi.nlm.nih.gov/pubmed/30684402 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e10323 %T A Hybrid Web-Based and In-Person Self-Management Intervention Aimed at Preventing Acute to Chronic Pain Transition After Major Lower Extremity Trauma: Feasibility and Acceptability of iPACT-E-Trauma %A Bérubé,Mélanie %A Gélinas,Céline %A Feeley,Nancy %A Martorella,Géraldine %A Côté,José %A Laflamme,G Yves %A Rouleau,Dominique M %A Choinière,Manon %+ Centre intégré universitaire du Nord-de-l’Île-de-Montréal, Hôpital du Sacré-Coeur de Montréal, Trauma Program and Department of Nursing, 5400 Boulevard Gouin Ouest, Montreal, QC, H4J 1C5, Canada, 1 514 338 2222 ext 2654, melanie.berube2@mail.mcgill.ca %K Acute pain %K chronic pain %K wound and injuries %K lower extremity %K self-care %K health promotion %K feasibility studies %K patient acceptance of health care %D 2018 %7 30.04.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: A transition from acute to chronic pain frequently occurs after major lower extremity trauma. While the risk factors for developing chronic pain in this population have been extensively studied, research findings on interventions aiming to prevent chronic pain in the trauma context are scarce. Therefore, we developed a hybrid, Web-based and in-person, self-management intervention to prevent acute to chronic pain transition after major lower extremity trauma (iPACT-E-Trauma). Objective: This study aimed to assess the feasibility and acceptability of iPACT-E-Trauma. Methods: Using a descriptive design, the intervention was initiated at a supra-regional level-1 trauma center. Twenty-eight patients ≥18 years old with major lower extremity trauma, presenting with moderate to high pain intensity 24 hours post-injury were recruited. Feasibility assessment was two-fold: 1) whether the intervention components could be provided as planned to ≥80% of participants and 2) whether ≥80% of participants could complete the intervention. The rates for both these variables were calculated. The E-Health Acceptability Questionnaire and the Treatment Acceptability and Preference Questionnaire were used to assess acceptability. Mean scores were computed to determine the intervention’s acceptability. Results: More than 80% of participants received the session components relevant to their condition. However, the Web pages for session 2, on the analgesics prescribed, were accessed by 71% of participants. Most sessions were delivered according to the established timeline for ≥80% of participants. Session 3 and in-person coaching meetings had to be provider earlier for ≥35% of participants. Session duration was 30 minutes or less on average, as initially planned. More than 80% of participants attended sessions and <20% did not apply self-management behaviors relevant to their condition, with the exception of deep breathing relaxation exercises which was not applied by 40% of them. Web and in-person sessions were assessed as very acceptable (mean scores ≥3 on a 0 to 4 descriptive scale) across nearly all acceptability attributes. Conclusions: Findings showed that the iPACT-E-Trauma intervention is feasible and was perceived as highly acceptable by participants. Further tailoring iPACT-E-Trauma to patient needs, providing more training time for relaxation techniques, and modifying the Web platform to improve its convenience could enhance the feasibility and acceptability of the intervention. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 91987302; http://www.controlled-trials.com/ISRCTN91987302 (Archived by WebCite at http://www.webcitation.org/6ynibjPHa) %M 30684418 %R 10.2196/10323 %U http://formative.jmir.org/2018/1/e10323/ %U https://doi.org/10.2196/10323 %U http://www.ncbi.nlm.nih.gov/pubmed/30684418 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e8 %T MedFit App, a Behavior-Changing, Theoretically Informed Mobile App for Patient Self-Management of Cardiovascular Disease: User-Centered Development %A Duff,Orlaith %A Walsh,Deirdre %A Malone,Shauna %A McDermott,Lauri %A Furlong,Brona %A O'Connor,Noel %A Moran,Kieran %A Woods,Catherine %+ School of Health and Human Performance, Dublin City University, Glasnevin,, Dublin, 9, Ireland, 353 17008011, kieran.moran@dcu.ie %K app development %K cardiac rehabilitation %K telemedicine %K exercise %K mHealth %K focus groups %K usability testing %D 2018 %7 27.04.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The MedFit app is designed to facilitate participation of people with cardiovascular disease (CVD) in an exercise-based rehabilitation program remotely. This paper details the development for the MedFit app. Objective: The aim of this research was to develop a behavior change, theoretically informed exercise rehabilitation mobile app for adults with CVD by following the early stages of the formative research: development and feasibility testing. Methods: Adhering to the mobile health (mHealth) development evaluation framework, the stages of the formative research process including (1) development and (2) feasibility were undertaken. The content and format of the MedFit app were developed based on (1) theory, (2) usability testing, and (3) content design. Results: A systematic review of the literature was undertaken to identify the most appropriate theories from which to develop the app. This led to the creation of the MedFit app. The app went through iterative rounds of usability focus group testing with adults with CVD to provide feedback on the app. This process was framed by the unified theory of acceptance and use of technology model. Feedback was then translated into feasible technical improvements to be executed through close collaboration with the technical team, who adapted and made modifications to the app based on this codesign process. Conclusions: The formative research process of the app development involved theoretical underpinning, usability testing, and content design. mHealth interventions may play a key role in the future of health care, potentially addressing the barriers to participation in cardiac rehabilitation. This work will provide guidance for future research aiming to develop mobile apps by incorporating a best practice framework for mHealth intervention development and a user-centered design approach. %M 30684426 %R 10.2196/formative.9550 %U http://formative.jmir.org/2018/1/e8/ %U https://doi.org/10.2196/formative.9550 %U http://www.ncbi.nlm.nih.gov/pubmed/30684426 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 2 %P e30 %T Worker Preferences for a Mental Health App Within Male-Dominated Industries: Participatory Study %A Peters,Dorian %A Deady,Mark %A Glozier,Nick %A Harvey,Samuel %A Calvo,Rafael A %+ Wellbeing Technology Lab, Faculty of Engineering and IT, University of Sydney, Bldg J03, Electrical Engineering, Sydney, 2006, Australia, 61 0289015604, dorian.peters@sydney.edu.au %K mental health %K mhealth %K mobile apps %K workplace %K men %K participatory design %D 2018 %7 25.04.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Men are less likely to seek help for mental health problems, possibly because of stigma imposed by cultural masculine norms. These tendencies may be amplified within male-dominated workplaces such as the emergency services or transport industries. Mobile apps present a promising way to provide access to mental health support. However, little is known about the kinds of mental health technologies men would be willing to engage with, and no app can be effective if the intended users do not engage with it. Objective: The goal of this participatory user research study was to explore the perceptions, preferences, and ideas of workers in male-dominated workplaces to define requirements for a mental health app that would be engaging and effective at improving psychological well-being. Methods: Workers from male-dominated workplaces in rural, suburban, and urban locations took part in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for mental health support and the design of an app for mental health. Participants generated a number of artifacts (including draft screen designs and promotional material) designed to reify their perceptions, tacit knowledge, and ideas. Results: A total of 60 workers aged between 26 and 65 years, 92% (55/60) male, from male-dominated workplaces in rural (16/60, 27%), suburban (14/60, 23%), and urban (30/60, 50%) locations participated in one of the 6 workshops, resulting in 49 unique feature ideas and 81 participant-generated artifacts. Thematic analysis resulted in a set of feature, language, and style preferences, as well as characteristics considered important by participants for a mental health app. The term “mental health” was highly stigmatized and disliked by participants. Tools including a mood tracker, self-assessment, and mood-fix tool were highly valued, and app characteristics such as brevity of interactions, minimal on-screen text, and a solutions-oriented approach were considered essential by participants. Some implementation strategies based on these findings are included in the discussion. Conclusions: Future mental health mobile phone apps targeting workers in male-dominated workplaces need to consider language use and preferred features, as well as balance the preferences of users with the demands of evidence-based intervention. In addition to informing the development of mental health apps for workers in male-dominated industries, these findings may also provide insights for mental health technologies, for men in general, and for others in high-stigma environments. %M 29695371 %R 10.2196/mental.8999 %U http://mental.jmir.org/2018/2/e30/ %U https://doi.org/10.2196/mental.8999 %U http://www.ncbi.nlm.nih.gov/pubmed/29695371 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 4 %P e78 %T A Website Supporting Sensitive Religious and Cultural Advance Care Planning (ACPTalk): Formative and Summative Evaluation %A Pereira-Salgado,Amanda %A Mader,Patrick %A O'Callaghan,Clare %A Boyd,Leanne %+ Centre for Nursing Research, Cabrini Institute, 154 Wattletree Road, Malvern, VIC, 3144, Australia, 61 395083436, apereira-salgado@cabrini.com.au %K advance care planning %K ehealth %K religion %K culture %K health personnel %D 2018 %7 16.04.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Advance care planning (ACP) promotes conversations about future health care needs, enacted if a person is incapable of making decisions at end-of-life that may be communicated through written documentation such as advance care directives. To meet the needs of multicultural and multifaith populations in Australia, an advance care planning website, ACPTalk, was funded to support health professionals in conducting conversations within diverse religious and cultural populations. ACPTalk aimed to provide religion-specific advance care planning content and complement existing resources. Objective: The purpose of this paper was to utilize the context, input, process, and product (CIPP) framework to conduct a formative and summative evaluation of ACPTalk. Methods: The CIPP framework was used, which revolves around 4 aspects of evaluation: context, input, process, and product. Context: health professionals’ solutions for the website were determined through thematic analysis of exploratory key stakeholder interviews. Included religions were determined through an environmental scan, Australian population statistics, and documentary analysis of project steering committee meeting minutes. Input: Project implementation and challenges were examined through documentary analysis of project protocols and meeting minutes. Process: To ensure religion-specific content was accurate and appropriate, a website prototype was built with content review and functionality testing by representatives from religious and cultural organizations and other interested health care organizations who completed a Web-based survey. Product: Website analytics were used to report utilization, and stakeholder perceptions were captured through interviews and a website survey. Results: Context: A total of 16 key stakeholder health professional (7 general practitioners, 2 primary health nurses, and 7 palliative care nurses) interviews were analyzed. Website solutions included religious and cultural information, communication ideas, legal information, downloadable content, and Web-based accessibility. Christian and non-Christian faiths were to be included in the religion-specific content. Input: Difficulties gaining consensus on religion-specific content were overcome by further state and national religious organizations providing feedback. Process: A total of 37 content reviewers included representatives of religious and cultural organizations (n=29), health care (n=5), and community organizations (n=3). The majority strongly agree or agree that the content used appropriate language and tone (92%, 34/37), would support health professionals (89%, 33/37), and was accurate (83%, 24/29). Product: Resource usage within the first 9 months was 12,957 page views in 4260 sessions; majority were (83.45%, 3555/4260) from Australia. A total of 107 Australian-based users completed the website survey; most felt information was accurate (77.6%, 83/107), easy to understand (82.2%, 88/107), useful (86.0%, 92/107), and appropriate (86.0%, 92/107). A total of 20 nurses (general practice n=10, palliative care n=8, and both disciplines n=2) participated in stakeholder interviews. Qualitative findings indicated overall positivity in relation to accessibility, functionality, usefulness, design, and increased knowledge of advance care planning. Recommended improvements included shortened content, a comparable website for patients and families, and multilingual translations. Conclusions: The CIPP framework was effectively applied to evaluate the development and end product of an advance care planning website.Although overall findings were positive, further advance care planning website development should consider the recommendations derived from this study. %M 29661749 %R 10.2196/resprot.8572 %U http://www.researchprotocols.org/2018/4/e78/ %U https://doi.org/10.2196/resprot.8572 %U http://www.ncbi.nlm.nih.gov/pubmed/29661749 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e7 %T Development of a Web-based Family Intervention for BRCA Carriers and Their Biological Relatives: Acceptability, Feasibility, and Usability Study %A Katapodi,Maria C %A Jung,Miyeon %A Schafenacker,Ann M %A Milliron,Kara J %A Mendelsohn-Victor,Kari E %A Merajver,Sofia D %A Northouse,Laurel L %+ Department of Public Health, Faculty of Medicine, University of Basel, Bernoullistrasse 28, Room 113, Basel, 4056, Switzerland, 41 79 109 5163, maria.katapodi@unibas.ch %K BRCA families %K family-based intervention study %K Web-based intervention study %K psycho-educational and skills-building intervention study %K communication and coping %K patient decision-aid %K genetic testing %D 2018 %7 13.04.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Carriers of breast cancer gene (BRCA) mutations are asked to communicate genetic test results to their biological relatives to increase awareness of cancer risk and promote use of genetic services. This process is highly variable from family to family. Interventions that support communication of genetic test results, coping, and offer decision support in families harboring a pathogenic variant may contribute to effective management of hereditary cancer. Objective: The aim of this paper was to describe the development of the Family Gene Toolkit, a Web-based intervention targeting BRCA carriers and untested blood relatives, designed to enhance coping, family communication, and decision making. Methods: We present findings from focus groups regarding intervention acceptability and participant satisfaction and from a pre-post pilot study with random allocation to a wait-listed control group regarding intervention feasibility and usability. Results: The Family Gene Toolkit was developed by a multidisciplinary team as a psycho-educational and skills-building intervention. It includes two live webinar sessions and a follow-up phone call guided by a certified genetic counselor and a master’s prepared oncology nurse. Each live webinar includes two modules (total four modules) presenting information about BRCA mutations, a decision aid for genetic testing, and two skill-building modules for effective coping and family communication. Participants in focus groups (n=11) were highly satisfied with the intervention, reporting it to be useful and describing clearly the important issues. From the 12 dyads recruited in the pre-post pilot study (response rate 12/52, 23%), completion rate was 71% (10/14) for intervention and 40% (4/10) for wait-listed control groups. Conclusions: Acceptability and satisfaction with the Family Gene Toolkit is high. On the basis of the findings from usability and feasibility testing, modifications on timing, delivery mode, and recruitment methods have been implemented. Trial Registration: ClinicalTrials.gov NCT02154633; https://clinicaltrials.gov/ct2/show/NCT02154633 (Archived by WebCite at http://www.webcitation.org/6yYNvLPjv) %M 29653920 %R 10.2196/cancer.9210 %U http://cancer.jmir.org/2018/1/e7/ %U https://doi.org/10.2196/cancer.9210 %U http://www.ncbi.nlm.nih.gov/pubmed/29653920 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e61 %T Social Interaction Needs and Entertainment Approaches to Pregnancy Well-Being in mHealth Technology Design for Low-Income Transmigrant Women: Qualitative Codesign Study %A AlJaberi,Hana %+ Purdue Polytechnic Institute, Department of Computer Graphics Technology, Purdue University, 401 N Grant St, West Lafayette, IN, 47907, United States, 1 7654947505, aljaberi.hana@gmail.com %K mHealth %K mobile health %K participatory design %K pregnancy %K Caribbean %K immigrant women %D 2018 %7 13.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Low-income Caribbean transmigrant women face unique health challenges during pregnancy that set forth multidimensional implications for the design of mobile health (mHealth). Acknowledgment of the unique health needs of low-income Caribbean immigrant women in the United States and what that entails regarding technology design remains rarely examined in the literature of mHealth technologies. Objective: The goal of this study was to reveal the needs and gaps in mHealth interventions for pregnant immigrant women not yet realized in this field. These understandings reveal design opportunities for mHealth. Methods: The use of the qualitative participatory action research approach of codesign workshops in this study resulted in design solutions by the participants after reflecting on their earlier focus group discussions. The highlights are not the resulting designs per se but rather the inferences derived from the researcher reflecting on these designs. Results: The designs exposed two themes relevant to this paper. First, the participants desired the inclusion and rebuilding of social and organizational relationships in mHealth. The resulting designs formulate an understanding of the women’s health-related social support needs and how technology can facilitate them. Second, the participants wanted entertainment with an element of social participation incorporated in mHealth pregnancy management interventions. This brings attention to the role entertainment can add to the impact mHealth can deliver for pregnancy well-being. Conclusions: The study concluded with an examination of social and entertainment design implications that reveal pregnant immigrant women’s virtual health-related sharing habits, choice of sharing interaction scenarios during pregnancy (eg, local, long distance, one-way, two-way, and many-many), and choice of sharing media (eg, text, voice, and video). Additionally, the study revealed exclusions to social sharing capabilities in health technologies for these women. %M 29653919 %R 10.2196/mhealth.7708 %U http://mhealth.jmir.org/2018/4/e61/ %U https://doi.org/10.2196/mhealth.7708 %U http://www.ncbi.nlm.nih.gov/pubmed/29653919 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e7 %T User-Centered Design of a Mobile App for Weight and Health Management in Adolescents With Complex Health Needs: Qualitative Study %A Rivera,Jordan %A McPherson,Amy C %A Hamilton,Jill %A Birken,Catherine %A Coons,Michael %A Peters,Michelle %A Iyer,Sindoora %A George,Tessy %A Nguyen,Cynthia %A Stinson,Jennifer %+ The Hospital for Sick Children, 686 Bay Street, Toronto, ON, M5G0A4, Canada, 1 416 813 7654 ext 304514, jennifer.stinson@sickkids.ca %K obesity %K weight loss %K adolescent %K mobile apps %D 2018 %7 04.04.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Growing research has been conducted into the deployment and evaluation of mobile technology interventions for weight management in adolescents. However, no work has yet been conducted toward the development of these technologies for adolescents with complex health needs receiving specialized tertiary-level health care. Objective: The aim of this study was to conduct a user-centered needs assessment of adolescents interested in weight management with complex health needs requiring specialized health care services, their parents, and health care providers (HCPs) to inform the design and development of a mobile app for weight and health management. Methods: A qualitative study design was employed. Participants were recruited from two tertiary health care centers. Separate audiotaped focus group interviews were conducted with adolescents aged 12 to 18 years, parents, and HCPs. Interviews were transcribed, and field notes were collected by research staff. Iterative simple content analysis was performed independently by 4 research team members using computer software NVivo (QSR International) 10.0. Results: A total of 19 adolescents, 16 parents, and 21 HCPs were interviewed. Qualitative analysis revealed seven major themes related to app functionality: healthy eating, social support, self-monitoring, communicating with HCPs, supporting mental health, gamification and incentives, and user interface (UI) design. Adolescents provided several ideas related to each feature, whereas parents’ views focused on assistance with meal planning and greater access to HCPs. HCPs viewed the app as a novel and more acceptable platform to connect remotely with adolescents than conventional methods. They also strongly endorsed the value of social support capabilities and the ability to connect with an HCP. Conclusions: This is the first study to conduct a qualitative needs assessment in adolescents receiving specialized health care services toward the design of a mobile app for weight and health management. Our results indicate that core components of the app should include tailored meal recommendations and assistance with meal planning, social networking for peer support, customized and convenient tracking, remote access to HCPs, features to support mental health, and an attractive and engaging UI. These findings will be used to develop and evaluate a mobile app targeting adolescents with complex health needs. %M 30684409 %R 10.2196/formative.8248 %U http://formative.jmir.org/2018/1/e7/ %U https://doi.org/10.2196/formative.8248 %U http://www.ncbi.nlm.nih.gov/pubmed/30684409 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e5 %T A Spiritually-Based Text Messaging Program to Increase Cervical Cancer Awareness Among African American Women: Design and Development of the CervixCheck Pilot Study %A Le,Daisy %A Aldoory,Linda %A Garza,Mary A %A Fryer,Craig S %A Sawyer,Robin %A Holt,Cheryl L %+ Department of Behavioral and Community Health, School of Public Health, University of Maryland, 1101H School of Public Health Building (255), College Park, MD, 20742, United States, 1 415 385 7330, drdaisyle@gmail.com %K short message service %K text messaging %K African Americans %K women’s health %K cervical cancer %K health status disparities %K pap test %K cancer screening %K health information technology %K spirituality %K community-based participatory research %D 2018 %7 29.03.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Although Hispanic women have the highest cervical cancer incidence rate, African American women account for a disproportionate burden of cervical cancer incidence and mortality when compared with non-Hispanic white women. Given that religion occupies an essential place in African American lives, delivering health messages through a popular communication delivery channel and framing them with important spiritual themes may allow for a more accessible and culturally appropriate approach to promoting cervical cancer educational content to African American women. Objective: The aim of this paper was to describe the design and development of the CervixCheck project, a spiritually based short message service (SMS) text messaging pilot intervention to increase cervical cancer awareness and Papanicolaou test screening intention among church-attending African American women aged 21 to 65 years. Methods: Through focus group interviews (n=15), formative research was conducted to explore facilitators, motivators, and barriers to cervical cancer screening. The interviews were also used to identify logistical factors that should be considered when developing the CervixCheck intervention. Culturally appropriate and spiritually grounded SMS text messages were developed based on the analysis of focus group data and the review of previous studies that incorporated technology into health behavior change interventions. After the CervixCheck intervention was developed, cognitive response interviews (n=8) were used to review the content of the SMS text messaging library, to ensure that the content was acceptable and understandable, particularly for church-attending African American women aged 21 to 65 years. Results: Design and development of the SMS text messages involved consideration of the content of the messages and technological specifications. Focus group participants overwhelmingly reported cell phone use and an interest in receiving spiritually based SMS text messages on cervical cancer prevention and early detection. Findings from the cognitive response interviews revealed that the content of the SMS text messaging library was acceptable and understandable with the target population. The revised SMS text messaging library currently includes 22 messages for delivery over 16 days, averaging 11 texts per week, with no more than two messages delivered per day. Initial usability testing also showed early feasibility. Conclusions: The design and development of the CervixCheck intervention provides important insight into what may be considered an overlooked minority population and missed opportunity in health information technology research. With increased internet penetration through the use of mobile phones, it is appropriate to investigate the viability of technology as a means to reach minority communities and to reduce health disparities. %M 30684433 %R 10.2196/formative.8112 %U http://formative.jmir.org/2018/1/e5/ %U https://doi.org/10.2196/formative.8112 %U http://www.ncbi.nlm.nih.gov/pubmed/30684433 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 1 %P e4 %T Development of an Exergame to Deliver a Sustained Dose of High-Intensity Training: Formative Pilot Randomized Trial %A McBain,Thomas %A Weston,Matthew %A Crawshaw,Paul %A Haighton,Catherine %A Spears,Iain %+ Academy of Sport and Physical Activity, Sheffield Hallam University, Collegiate Hall, Collegiate Crescent, Sheffield, S102BP, United Kingdom, 44 1142255805, t.mcbain@shu.ac.uk %K high-intensity interval training %K video games %K heart rate %K boxing %K metabolic syndrome %D 2018 %7 27.03.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Sport science can play a critical role in reducing health inequalities. The inverse relationship between life expectancy, cardiorespiratory fitness, and socioeconomic status could be addressed by performing high-intensity training (HIT), delivered in a class salient and accessible approach. Commercially available exergames have shown encouraging compliance rates but are primarily designed for entertainment purposes rather than focusing on health-related outcomes. A serious game tailored toward delivering an exercise stimulus, while reducing the aversive protocols associated with HIT, could be beneficial to engage and improve health outcomes in socially deprived males. Objective: The aims of this study were to develop an exergame capable of delivering HIT and evaluate the effect on selected health outcomes in men recruited in regions of socioeconomic deprivation. Methods: We conducted an exploratory trial in our target population, and participants were allocated to intervention (n=14) or control groups (n=10) by third-party minimization. The intervention was a 6-week training program consisting of three sessions of exergaming per week. The sessions involved a structured warm-up, then brief intermittent repetitions in the form of boxing rounds (10 s, 20 s, and 30 s) against their peers with a work/rest ratio of 0.25. Results: Retention to the intervention was 87.5% (21/24). Over the duration of the intervention, session attendance was 67.5% (170/252); repetition mean and peak heart rates (% of maximal) and session ratings of perceived exertion (AU, arbitrary units) were 86.3 (5.4%), 89.9 (6.1%), and 7.5 (2.2 AU), respectively. The effect of the intervention, when compared with the control, was a likely small beneficial improvement in predicted maximum oxygen consumption (VO2 max, 3.0; 90% confidence limits ±2.6%). Effects on body mass, waist circumference, and blood pressure were either trivial or unclear. Conclusions: Over the 6-week intervention, the exergame delivered a consistent and sustained dose of HIT, with some beneficial effects on aerobic fitness in the target population. Trial Registration: ClinicalTrials.gov NCT03477773; https://clinicaltrials.gov/ct2/show/NCT03477773 (Archived by WebCite at http://www.webcitation.org/6yDLgVs35) %M 29588271 %R 10.2196/games.7758 %U http://games.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/games.7758 %U http://www.ncbi.nlm.nih.gov/pubmed/29588271 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e6 %T Factors Affecting Patient Portal Use Among Low-Income Pregnant Women: Mixed-Methods Pilot Study %A Kim,Juhee %A Mathews,Holly %A Cortright,Lindsay M %A Zeng,Xiaoming %A Newton,Edward %+ Department of Public Health, Brody School of Medicine, East Carolina University, 1600 Moye Blvd, Lakeside Annex 7, Greenville, NC, 27858, United States, 1 252 744 5575, kimju@ecu.edu %K patient portals %K digital divide %K pregnancy %K poverty %K health literacy %D 2018 %7 22.03.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Patient portals offer patients personalized and secure Web access to their medical information and enable patients to manage their health care online. However, there is a lack of information about patient acceptance and use of patient portals among low-income pregnant women. Objective: This formative research aims to assess the potential of a patient portal, MyChart, for improving prenatal health care and pregnancy outcomes, and identify the barriers and facilitators of MyChart use among low-income pregnant women. Methods: A mixed-methods study was conducted with a convenience sample of 18 low-income pregnant women comprising low- and high-risk patients enrolled in a prenatal clinic in eastern North Carolina. MyChart use, patient demographics, and pregnancy information were collected by reviewing electronic medical charts. Health literacy was measured. Reported use and attitudes toward MyChart were collected using a semi-structured interview. Results: Although 39% (7/18) of participants interviewed signed up for MyChart, only 22% (4/18) of them became active users. Another 33% (6/18) had never heard of MyChart or was unsure of how to access it. Users primarily accessed test results and appointment schedules. The main facilitating factors for patient portal use were information and motivation from health care providers and concerns about pregnancy due to a history of miscarriage. Reported barriers were lack of educational resources, lack of care provider encouragement, and technical difficulties possibly exacerbated by low health literacy. Participants also suggested improvements for MyChart, especially the provision of discussion-based support for pregnant women. Conclusions: The one-time verbal introduction of MyChart does not meet current patients’ needs. Data reveal the need for more consistent patient education and support programs, tailored to patients’ previous pregnancy histories. The clinic also needs to facilitate better provider-patient communication about the importance of MyChart use. %M 30684413 %R 10.2196/formative.5322 %U http://formative.jmir.org/2018/1/e6/ %U https://doi.org/10.2196/formative.5322 %U http://www.ncbi.nlm.nih.gov/pubmed/30684413 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e21 %T A Web-Based Toolkit to Provide Evidence-Based Resources About Crystal Methamphetamine for the Australian Community: Collaborative Development of Cracks in the Ice %A Champion,Katrina Elizabeth %A Chapman,Cath %A Newton,Nicola Clare %A Brierley,Mary-Ellen %A Stapinski,Lexine %A Kay-Lambkin,Frances %A Nagle,Jack %A Teesson,Maree %+ National Health and Medical Research Council Centre of Research Excellence in Mental Health and Substance Use, National Drug and Alcohol Research Centre, University of New South Wales, 22-32 King Street, Randwick, Sydney, 2052, Australia, 61 293850333, k.champion@unsw.edu.au %K methamphetamine %K substance-related disorders %K internet %K preventive psychiatry %K health education %D 2018 %7 20.03.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: The use of crystal methamphetamine (ice) and the associated harms for individuals, families, and communities across Australia has been the subject of growing concern in recent years. The provision of easily accessible, evidence-based, and up-to-date information and resources about crystal methamphetamine for the community is a critical component of an effective public health response. Objective: This paper aims to describe the codevelopment process of the Web-based Cracks in the Ice Community Toolkit, which was developed to improve access to evidence-based information and resources about crystal methamphetamine for the Australian community. Methods: Development of the Cracks in the Ice Community Toolkit was conducted in collaboration with community members across Australia and with experts working in the addiction field. The iterative process involved the following: (1) consultation with end users, including community members, crystal methamphetamine users, families and friends of someone using crystal methamphetamine, health professionals, and teachers (n=451) via a cross-sectional Web-based survey to understand information needs; (2) content and Web development; and (3) user testing of a beta version of the Web-based toolkit among end users (n=41) and experts (n=10) to evaluate the toolkit’s acceptability, relevance, and appeal. Results: Initial end user consultation indicated that the most commonly endorsed reasons for visiting a website about crystal methamphetamine were “to get information for myself” (185/451, 41.0%) and “to find out how to help a friend or a family member” (136/451, 30.2%). Community consultation also revealed the need for simple information about crystal methamphetamine, including what it is, its effects, and when and where to seek help or support. Feedback on a beta version of the toolkit was positive in terms of content, readability, layout, look, and feel. Commonly identified areas for improvement related to increasing the level of engagement and personal connection, improving the ease of navigation, and balancing a “low prevalence of use, yet high impact” message. A total of 9138 users visited the website in the 3 months immediately post launch, and over 25,000 hard-copy Cracks in the Ice booklets and flyers were distributed across Australia. Of these resources, 60.93% (15,525/25,480) were distributed to relevant organizations and mailing list subscribers, and 39.07% (9955/25,480) were ordered directly by individuals, services, and community groups via the Cracks in the Ice website. Conclusions: The codevelopment process resulted in an engaging Web-based resource for the Australian community to access up-to-date and evidence-based resources about crystal methamphetamine. The Cracks in the Ice Community Toolkit provides much-needed information and support for individuals, families, and communities. %M 29559427 %R 10.2196/mental.8891 %U http://mental.jmir.org/2018/1/e21/ %U https://doi.org/10.2196/mental.8891 %U http://www.ncbi.nlm.nih.gov/pubmed/29559427 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e66 %T An mHealth Pain Coping Skills Training Intervention for Hematopoietic Stem Cell Transplantation Patients: Development and Pilot Randomized Controlled Trial %A Somers,Tamara J %A Kelleher,Sarah A %A Dorfman,Caroline S %A Shelby,Rebecca A %A Fisher,Hannah M %A Rowe Nichols,Krista %A Sullivan,Keith M %A Chao,Nelson J %A Samsa,Gregory P %A Abernethy,Amy P %A Keefe,Francis J %+ Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W Main St, Ste 340, Durham, NC, 27705, United States, 1 919 416 3408, tamara.somers@duke.edu %K stem cell transplantation %K hematopoietic stem cell %K cancer-related pain %K coping skills %D 2018 %7 19.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pain is a challenge for patients following hematopoietic stem cell transplantation (HCT). Objective: This study aimed to develop and test the feasibility, acceptability, and initial efficacy of a Web-based mobile pain coping skills training (mPCST) protocol designed to address the needs of HCT patients. Methods: Participants had undergone HCT and reported pain following transplant (N=68). To guide intervention development, qualitative data were collected from focus group participants (n=25) and participants who completed user testing (n=7). After their input was integrated into the mPCST intervention, a pilot randomized controlled trial (RCT, n=36) was conducted to examine the feasibility, acceptability, and initial efficacy of the intervention. Measures of acceptability, pain severity, pain disability, pain self-efficacy, fatigue, and physical disability (self-report and 2-min walk test [2MWT]) were collected. Results: Participants in the focus groups and user testing provided qualitative data that were used to iteratively refine the mPCST protocol. Focus group qualitative data included participants’ experiences with pain following transplant, perspectives on ways to cope with pain, and suggestions for pain management for other HCT patients. User testing participants provided feedback on the HCT protocol and information on the use of videoconferencing. The final version of the mPCST intervention was designed to bridge the intensive outpatient (1 in-person session) and home settings (5 videoconferencing sessions). A key component of the intervention was a website that provided personalized messages based on daily assessments of pain and activity. The website also provided intervention materials (ie, electronic handouts, short videos, and audio files). The intervention content included pain coping advice from other transplant patients and instructions on how to apply pain coping skills while engaging in meaningful and leisure activities. In the RCT phase of this research, HCT patients (n=36) were randomized to receive the mPCST intervention or to proceed with the treatment as usual. Results revealed that the mPCST participants completed an average of 5 out of 6 sessions. The participants reported that the intervention was highly acceptable (mean 3/4), and they found the sessions to be helpful (mean 8/10) and easy to understand (mean 7/7). The mPCST participants demonstrated significant improvements in pre- to post-treatment pain, self-efficacy (P=.03, d=0.61), and on the 2MWT (P=.03, d=0.66), whereas the patients in the treatment-as-usual group did not report any such improvements. Significant changes in pain disability and fatigue were found in both groups (multiple P<.02); the magnitudes of the effect sizes were larger for the mPCST group than for the control group (pain disability: d=0.79 vs 0.69; fatigue: d=0.94 vs 0.81). There were no significant changes in pain severity in either group. Conclusions: Using focus groups and user testing, we developed an mPCST protocol that was feasible, acceptable, and beneficial for HCT patients with pain. Trial Registration: ClinicalTrials.gov NCT01984671; https://clinicaltrials.gov/ct2/show/NCT01984671 (Archived by WebCite at http://www.webcitation.org/6xbpx3clZ) %M 29555620 %R 10.2196/mhealth.8565 %U http://mhealth.jmir.org/2018/3/e66/ %U https://doi.org/10.2196/mhealth.8565 %U http://www.ncbi.nlm.nih.gov/pubmed/29555620 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e4 %T A Web-Based Platform for People With Memory Problems and Their Caregivers (CAREGIVERSPRO-MMD): Mixed-Methods Evaluation of Usability %A Zafeiridi,Paraskevi %A Paulson,Kevin %A Dunn,Rosie %A Wolverson,Emma %A White,Caroline %A Thorpe,Jonathan Adrian %A Antomarini,Marco %A Cesaroni,Francesca %A Scocchera,Francesca %A Landrin-Dutot,Isabelle %A Malherbe,Laëtitia %A Lingiah,Hendi %A Bérard,Marie %A Gironès,Xavier %A Quintana,Maria %A Cortés,Ulises %A Barrué,Cristian %A Cortés,Atia %A Paliokas,Ioannis %A Votis,Konstantinos %A Tzovaras,Dimitrios %+ School of Engineering and Computer Science, University of Hull, Aire Building, Cottingham Road, Hull, HU67RX, United Kingdom, 44 01482464571 ext 4571, P.Zafeiridi@hull.ac.uk %K dementia %K technology %K social support %K caregivers %D 2018 %7 12.03.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The increasing number of people with dementia (PwD) drives research exploring Web-based support interventions to provide effective care for larger populations. In this concept, a Web-based platform (CAREGIVERSPRO-MMD, 620911) was designed to (1) improve the quality of life for PwD, (2) reduce caregiver burden, (3) reduce the financial costs for care, and (4) reduce administration time for health and social care professionals. Objective: The objective of this study was to evaluate the usability and usefulness of CAREGIVERSPRO-MMD platform for PwD or mild cognitive impairment (MCI), informal caregivers, and health and social care professionals with respect to a wider strategy followed by the project to enhance the user-centered approach. A secondary aim of the study was to collect recommendations to improve the platform before the future pilot study. Methods: A mixed methods design was employed for recruiting PwD or MCI (N=24), informal caregivers (N=24), and professionals (N=10). Participants were asked to rate their satisfaction, the perceived usefulness, and ease of use of each function of the platform. Qualitative questions about the improvement of the platform were asked when participants provided low scores for a function. Testing occurred at baseline and 1 week after participants used the platform. The dropout rate from baseline to the follow-up was approximately 10% (6/58). Results: After 1 week of platform use, the system was useful for 90% (20.75/23) of the caregivers and for 89% (5.36/6) of the professionals. When users responded to more than 1 question per platform function, the mean of satisfied users per function was calculated. These user groups also provided positive evaluations for the ease of use (caregivers: 82%, 18.75/23; professionals: 97%, 5.82/6) and their satisfaction with the platform (caregivers: 79%, 18.08/23; professionals: 73%, 4.36/6). Ratings from PwD were lower than the other groups for usefulness (57%, 13/23), ease of use (41%, 9.4/23), and overall satisfaction (47%, 11/23) with the platform (P<.05). Qualitative comments related to both improvements for functionality and the platform interface. Conclusions: Although caregivers and professionals were overall satisfied with the platform, further adaptations were recommended by PwD. This reiterates the importance of the involvement of end users in the development of Web-based interventions. Recommendations from users in this paper apply for the interface and functionality of a wider range of Web-based support interventions. %M 30684403 %R 10.2196/formative.9083 %U http://formative.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/formative.9083 %U http://www.ncbi.nlm.nih.gov/pubmed/30684403 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e51 %T More Stamina, a Gamified mHealth Solution for Persons with Multiple Sclerosis: Research Through Design %A Giunti,Guido %A Mylonopoulou,Vasiliki %A Rivera Romero,Octavio %+ Salumedia Tecnologias, Avda. Republica Argentina nº 24, Edificio Torre de los Remedios 5ª planta modulo A, Sevilla, 41011, Spain, 34 717702622, drguidogiunti@gmail.com %K multiple sclerosis %K telemedicine %K fatigue %K mobile applications %K video games %K qualitative research %K exercise %K chronic disease %K user-computer interface %K software design %D 2018 %7 02.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Multiple sclerosis (MS) is one of the world’s most common neurologic disorders. Fatigue is one of most common symptoms that persons with MS experience, having significant impact on their quality of life and limiting their activity levels. Self-management strategies are used to support them in the care of their health. Mobile health (mHealth) solutions are a way to offer persons with chronic conditions tools to successfully manage their symptoms and problems. Gamification is a current trend among mHealth apps used to create engaging user experiences and is suggested to be effective for behavioral change. To be effective, mHealth solutions need to be designed to specifically meet the intended audience needs. User-centered design (UCD) is a design philosophy that proposes placing end users’ needs and characteristics in the center of design and development, involving users early in the different phases of the software life cycle. There is a current gap in mHealth apps for persons with MS, which presents an interesting area to explore. Objective: The purpose of this study was to describe the design and evaluation process of a gamified mHealth solution for behavioral change in persons with MS using UCD. Methods: Building on previous work of our team where we identified needs, barriers, and facilitators for mHealth apps for persons with MS, we followed UCD to design and evaluate a mobile app prototype aimed to help persons with MS self-manage their fatigue. Design decisions were evidence-driven and guided by behavioral change models (BCM). Usability was assessed through inspection methods using Nielsen’s heuristic evaluation. Results: The mHealth solution More Stamina was designed. It is a task organization tool designed to help persons with MS manage their energy to minimize the impact of fatigue in their day-to-day life. The tool acts as a to-do list where users can input tasks in a simple manner and assign Stamina Credits, a representation of perceived effort, to the task to help energy management and energy profiling. The app also features personalization and positive feedback. The design process gave way to relevant lessons to the design of a gamified behavioral change mHealth app such as the importance of metaphors in concept design, negotiate requirements with the BCM constructs, and tailoring of gamified experiences among others. Several usability problems were discovered during heuristic evaluation and guided the iterative design of our solution. Conclusions: In this paper, we designed an app targeted for helping persons with MS in their fatigue management needs. We illustrate how UCD can help in designing mHealth apps and the benefits and challenges that designers might face when using this approach. This paper provides insight into the design process of gamified behavioral change mHealth apps and the negotiation process implied in it. %M 29500159 %R 10.2196/mhealth.9437 %U http://mhealth.jmir.org/2018/3/e51/ %U https://doi.org/10.2196/mhealth.9437 %U http://www.ncbi.nlm.nih.gov/pubmed/29500159 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 3 %P e52 %T Crush the Crave: Development and Formative Evaluation of a Smartphone App for Smoking Cessation %A Baskerville,Neill B %A Struik,Laura L %A Dash,Darly %+ Propel Centre for Population Health Impact, Faculty of Applied Health Sciences, University of Waterloo, 200 University Ave West, Waterloo, ON, N2M 3G1, Canada, 1 519 888 4567 ext 35236, nbbaskerville@uwaterloo.ca %K mobile app %K smoking cessation %K young adult %K software design %K formative feedback %D 2018 %7 02.03.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Emerging evidence supports the use of smartphone apps for smoking cessation, especially in young adults given their high smoking rates and high smartphone ownership rates. Although evaluative evidence is encouraging for supporting smoking cessation, there remains a paucity of research describing the design and development processes of mobile health (mHealth) interventions. Objective: The aim of this paper was to describe the process of developing Crush the Crave (CTC), an evidence-informed app to support smoking cessation in young adults, and the results of a formative evaluation of app usage behavior, as part of a broader program of research that seeks to establish the effectiveness of the CTC app. Methods: The Spiral Technology Action Research (STAR) 5-cycle model (listen, plan, do, act, and study) was employed to guide the development, implementation, and dissemination of CTC. The approach to development and formative evaluation included focus groups with young adult smokers (n=78) across 2 phases, analysis of the content of existing apps, 2 sessions with content experts, and Google Analytics to assess user behavior during a 12-month pilot. Results: LISTEN—focus groups revealed young adult smoker preferences of (1) positive reinforcement, (2) personalization, (3) social support, (4) quit support, (5) tracking the behavior, and (6) tracking quit benefits. PLAN—informed by evidence for smoking cessation, young adult preferences and an assessment of popular cessation apps, content experts produced a mind map and a storyboard describing app content and structure. DO—focus groups with young adult smokers provided feedback on the first version of the app with opinions on content and suggestions for improvement such as providing alerts and distractions from craving. ACT—refinements were made, and app content was organized using the 4 key design components informed by principles of persuasive technology for behavior change: credibility, task support, dialogue support, and social support. CTC was launched in April 2013 and piloted from the period July 2013 to June 2014 where 1987 Android users had 18,567 sessions, resulting in 59,384 page views and 89.58% (1780/1987) of users returning within the same day to use CTC. STUDY—a pragmatic randomized controlled trial of CTC was launched in August 2014 to demonstrate that including mHealth technology as a population-based intervention can help young adult smokers to quit. The results of this phase will be presented in a subsequent publication. Conclusions: CTC is one of the first smoking cessation apps designed to meet the needs of young adult smokers. The development was informed by the inclusion of young adults in the design and the systematic application of multiple stakeholder input, scientific evidence, and theory. The STAR model approach was followed from the beginning of intervention development, which should facilitate optimization of mHealth interventions in the future. Trial Registration: ClinicalTrials.gov NCT01983150; http://clinicaltrials.gov/ct2/show/NCT01983150 (Archived by WebCite at http://www.webcitation.org/6VGyc0W0i) %M 29500157 %R 10.2196/mhealth.9011 %U http://mhealth.jmir.org/2018/3/e52/ %U https://doi.org/10.2196/mhealth.9011 %U http://www.ncbi.nlm.nih.gov/pubmed/29500157 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 1 %N 1 %P e1 %T Acceptability and Feasibility of a Trial Testing Allocation to Sunscreen and a Smartphone App for Sun Protection: Discontinued Randomized Controlled Trial %A Rodrigues,Angela M %A Sniehotta,Falko F %A Birch-Machin,Mark A %A Olivier,Patrick %A Araújo-Soares,Vera %+ Newcastle University, Baddiley-Clark Building, Richardson Road, Newcastle, NE2 4AX, United Kingdom, 44 191 208 8974, angela.rodrigues@newcastle.ac.uk %K sunscreening agents %K sun protection factor %K smartphone %K mobile applications %K feasibility studies %K randomized controlled trial %K skin neoplasms %K melanoma %K skin aging %K holidays %K health promotion %K health behavior %D 2018 %7 27.02.2018 %9 Original Paper %J JMIR Dermatol %G English %X Background: Recreational sun exposure has been associated with melanoma prevalence, and tourism settings are of particular interest for skin cancer prevention. Effective, affordable, and geographically flexible interventions to promote sun protection are needed. Objective: The aim of this study was to describe the protocol for a definitive randomized controlled trial (RCT) evaluating a smartphone mobile intervention (mISkin app) promoting sun protection in holidaymakers and to assess the acceptability and feasibility of the mISkin app and associated trial procedures in an internal pilot study. Methods: Participants were recruited from the general community. Holidaymakers traveling abroad and owning a smartphone were enrolled in the internal pilot of a 2 (mISkin vs control) x 2 (sun protection factor [SPF] 15 vs SPF 30) RCT with a postholiday follow-up. The smartphone app is fully automated and entails a behavioral intervention to promote sun protection. It consisted of five components: skin assessment, educational videos, ultraviolet (UV) photos, gamification, and prompts for sun protection. Participants were also randomly allocated to receive sunscreen SPF 15 or SPF 30. Primary outcomes for the internal pilot study were acceptability and feasibility of trial procedures and intervention features. Secondary outcomes were collected at baseline and after holidays through face-to-face-assessments and included skin sun damage, sunscreen use (residual weight and application events), and sun protection practices (Web-based questionnaire). Results: From 142 registers of interest, 42 participants were randomized (76% [32/42] female; mean age 35.5 years). Outcome assessments were completed by all participants. Random allocation to SPF 15 versus SPF 30 was found not to be feasible in a definitive trial protocol. Of the 21 people allocated to the mISkin intervention, 19 (91%) installed the mISkin on their phones, and 18 (86%) used it at least once. Participants were satisfied with the mISkin app and made suggestions for further improvements. Due to difficulties with the random allocation to SPF and slow uptake, the trial was discontinued. Conclusions: The internal pilot study concluded that randomization to SPF was not feasible and that recruitment rate was slower than expected because of difficulties with gatekeeper engagement. Possible solutions to the problems identified are discussed. Further refinements to the mISkin app are needed before a definitive trial. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN63943558; http://www.isrctn.com/ISRCTN63943558 (Archived by WebCite at http://www.webcitation.org/6xOLvbab8) %R 10.2196/derma.8608 %U https://derma.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/derma.8608 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e45 %T Mobile App Delivery of the EORTC QLQ-C30 Questionnaire to Assess Health-Related Quality of Life in Oncological Patients: Usability Study %A Kessel,Kerstin A %A Vogel,Marco ME %A Alles,Anna %A Dobiasch,Sophie %A Fischer,Hanna %A Combs,Stephanie E %+ Department of Radiation Oncology, Technical University of Munich, Ismaninger Straße 22, Munich, 81675, Germany, 49 0894140 ext 4502, kerstin.kessel@tum.de %K radiation oncology %K healthcare surveys %K mobile applications %K mobile apps %K telemedicine %K health-related quality of life %K questionnaires %K oncology  %D 2018 %7 20.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile apps are evolving in the medical field. However, ongoing discussions have questioned whether such apps are really valuable and whether patients will accept their use in day-to-day clinical life. Therefore, we initiated a usability study in our department. Objective: We present our results of the first app prototype and patient testing of health-related quality of life (HRQoL) assessment in oncological patients. Methods: We developed an app prototype for the iOS operating system within eight months in three phases: conception, initial development, and pilot testing. For the HRQoL assessment, we chose to implement only the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire-Core 30 (QLQ-C30; German version 3). Usability testing was conducted for three months. Participation was voluntary and pseudonymized. After completion of the QLQ-C30 questionnaire using iPads provided by our department, we performed a short survey with 10 questions. This survey inquired about patients’ opinions regarding general aspects, including technical advances in medicine, mobile and app assistance during cancer treatment, and the app-specific functions (eg, interface and navigation). Results: After logging into the app, the user can choose between starting a questionnaire, reviewing answers (administrators only), and logging out. The questionnaire is displayed with the same information, questions, and answers as on the original QLQ-C30 sheet. No alterations in wording were made. Usability was tested with 81 patients; median age was 55 years. The median time for completing the HRQoL questionnaire on the iPad was 4.0 minutes. Of all participants, 84% (68/81) owned a mobile device. Similarly, 84% (68/81) of participants would prefer a mobile version of the HRQoL questionnaire instead of a paper-based version. Using the app in daily life during and after cancer treatment would be supported by 83% (67/81) of participants. In the prototype version of the app, data were stored on the device; in the future, 79% (64/81) of the patients would agree to transfer data via the Internet. Conclusions: Our usability test showed good results regarding attractiveness, operability, and understandability. Moreover, our results demonstrate a high overall acceptance of mobile apps and telemedicine in oncology. The HRQoL assessment via the app was accepted thoroughly by patients, and individuals are keen to use it in clinical routines, while data privacy and security must be ensured. %M 29463489 %R 10.2196/mhealth.9486 %U http://mhealth.jmir.org/2018/2/e45/ %U https://doi.org/10.2196/mhealth.9486 %U http://www.ncbi.nlm.nih.gov/pubmed/29463489 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 2 %P e54 %T Healthy Body Image Intervention Delivered to Young Women via Facebook Groups: Formative Study of Engagement and Acceptability %A Stapleton,Jerod L %A Manne,Sharon L %A Day,Ashley K %A Levonyan-Radloff,Kristine %A Pagoto,Sherry L %+ Rutgers Cancer Institute of New Jersey, Department of Medicine, Rutgers University, 195 Little Albany Street, New Brunswick, NJ, 08901, United States, 1 732 235 8112, staplejl@cinj.rutgers.edu %K body image %K dissonance-based intervention %K indoor tanning bed %K social media %K Facebook %K behavioral intervention %K prevention %D 2018 %7 20.02.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: There is increasing interest in using social media sites such as Facebook to deliver health interventions so as to expose people to content while they are engaging in their usual social media habit. This formative intervention development study is novel in describing a preliminary test of using the secret group feature of Facebook to deliver a behavioral intervention targeting users of indoor tanning beds to reduce their risk of skin cancer. Intervention content was designed to challenge body image-related constructs associated with indoor tanning through the use of dissonance-inducing content. Objective: To evaluate engagement with and acceptability of using a secret Facebook group to deliver a healthy body image intervention to young women engaged in indoor tanning. Methods: Seventeen young women completed a baseline survey and joined a secret Facebook group with intervention content delivered via daily posts for 4 weeks. Engagement data was extracted and acceptability was measured via a follow-up survey. Results: The study had a high retention rate (94%, [16/17]). On average, posts were viewed by 91% of participants, liked by 35%, and commented on by 26%. The average comment rate was highest (65%) for posts that elicited comments by directly posing questions or discussion topics to the group. Average intervention acceptability ratings were highly positive and participants reported feeling connected to the group and its topic. Average rates of past 1-month indoor tanning reported following the intervention were lower than the baseline rate (P=.08, Cohen d=0.47). Conclusions: This study is novel in demonstrating participant engagement with and acceptability of using Facebook secret groups to deliver a dissonance-inducing intervention approach that utilizes group-based discussions related to body image. The study is also unique within the field of skin cancer prevention by demonstrating the potential value of delivering an indoor tanning intervention within an interactive social media format. The findings suggest that Facebook metrics of intervention post engagement (ie, likes and comments) may vary based on post types and that designing specifically labeled discussion posts may be helpful for soliciting engagement as well as challenging beliefs. %M 29463495 %R 10.2196/resprot.9429 %U http://www.researchprotocols.org/2018/2/e54/ %U https://doi.org/10.2196/resprot.9429 %U http://www.ncbi.nlm.nih.gov/pubmed/29463495 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 2 %P e44 %T A Smartphone App to Promote an Active Lifestyle in Lower-Educated Working Young Adults: Development, Usability, Acceptability, and Feasibility Study %A Simons,Dorien %A De Bourdeaudhuij,Ilse %A Clarys,Peter %A De Cocker,Katrien %A Vandelanotte,Corneel %A Deforche,Benedicte %+ Health Promotion and Education Unit, Department of Public Health, Ghent University, Corneel Heymanslaan 10, Ghent, 9000, Belgium, 32 498457442, dorien.simons@ugent.be %K mHealth %K young adult %K mobile applications %K physical activity %K active transport %K health promotion %D 2018 %7 20.02.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Physical activity (PA) levels are problematic in lower-educated working young adults (18-26 years). To promote PA, smartphone apps have great potential, but there is no evidence for their effectiveness in this population. To increase the likelihood that a newly developed app will be effective, formative research and user testing are required. Objective: The aim of this study was to describe the development, usability, acceptability, and feasibility of a new theory- and evidence-based smartphone app to promote an active lifestyle in lower-educated working young adults. Methods: The new app was developed by applying 4 steps. First, determinants important to promote an active lifestyle in this population were selected. Second, evidence-based behavior change techniques were selected to convert the determinants into practical applications. Third, a new smartphone app was developed. Fourth, volunteers (n=11, both lower and higher educated) tested the app on usability, and lower-educated working young adults (n=16) tested its acceptability and feasibility via (think aloud) interviews, a questionnaire, and Google Analytics. The app was accordingly adapted for the final version. Results: A new Android app, Active Coach, was developed that focused on knowledge, attitude, social support, and self-efficacy (based on outcomes from step 1), and that applied self-regulation techniques (based on outcomes from step 2). The app consists of a 9-week program with personal goals, practical tips, and scientific facts to encourage an active lifestyle. To ensure all-day and automatic self-monitoring of the activity behavior, the Active Coach app works in combination with a wearable activity tracker, the Fitbit Charge. Issues detected by the usability test (eg, text errors, wrong messages) were all fixed. The acceptability and feasibility test showed that participants found the app clear, understandable, and motivating, although some aspects needed to be more personal. Conclusions: By applying a stepwise, user-centered approach that regularly consulted the target group, the new app is adapted to their specific needs and preferences. The Active Coach app was overall positively evaluated by the lower-educated working young adults at the end of the development process. %M 29463491 %R 10.2196/mhealth.8287 %U http://mhealth.jmir.org/2018/2/e44/ %U https://doi.org/10.2196/mhealth.8287 %U http://www.ncbi.nlm.nih.gov/pubmed/29463491 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e13 %T A Web-Based Psychoeducational Intervention for Adolescent Depression: Design and Development of MoodHwb %A Bevan Jones,Rhys %A Thapar,Anita %A Rice,Frances %A Beeching,Harriet %A Cichosz,Rachel %A Mars,Becky %A Smith,Daniel J %A Merry,Sally %A Stallard,Paul %A Jones,Ian %A Thapar,Ajay K %A Simpson,Sharon A %+ Division of Psychological Medicine and Clinical Neurosciences, Medical Research Council Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Hadyn Ellis Building, Maindy Rd, Cardiff, Wales, CF24 4HQ, United Kingdom, 44 02920688451, bevanjonesr1@cardiff.ac.uk %K adolescent %K depression %K internet %K education %K preventive psychiatry %K early medical intervention %D 2018 %7 15.02.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Depression is common in adolescence and leads to distress and impairment in individuals, families and carers. Treatment and prevention guidelines highlight the key role of information and evidence-based psychosocial interventions not only for individuals but also for their families and carers. Engaging young people in prevention and early intervention programs is a challenge, and early treatment and prevention of adolescent depression is a major public health concern. There has been growing interest in psychoeducational interventions to provide accurate information about health issues and to enhance and develop self-management skills. However, for adolescents with, or at high risk of depression, there is a lack of engaging Web-based psychoeducation programs that have been developed with user input and in line with research guidelines and targeted at both the individual and their family or carer. There are also few studies published on the process of development of Web-based psychoeducational interventions. Objective: The aim of this study was to describe the process underlying the design and development of MoodHwb (HwbHwyliau in Welsh): a Web-based psychoeducation multimedia program for young people with, or at high risk of, depression and their families, carers, friends, and professionals. Methods: The initial prototype was informed by (1) a systematic review of psychoeducational interventions for adolescent depression; (2) findings from semistructured interviews and focus groups conducted with adolescents (with depressive symptoms or at high risk), parents or carers, and professionals working with young people; and (3) workshops and discussions with a multimedia company and experts (in clinical, research, and multimedia work). Twelve interviews were completed (four each with young people, parents or carers, and professionals) and six focus groups (three with young people, one with parents and carers, one with professionals, and one with academics). Results: Key themes from the interviews and focus groups were: aims of the program, design and content issues, and integration and context of the program. The prototype was designed to be person-centered, multiplatform, engaging, interactive, and bilingual. It included mood-monitoring and goal-setting components and was available as a Web-based program and an app for mobile technologies. Conclusions: MoodHwb is a Web-based psychoeducational intervention developed for young people with, or at high risk of, depression and their families and carers. It was developed with user input using qualitative methods as well as user-centered design and educational and psychological theory. Further research is needed to evaluate the effectiveness of the program in a randomized controlled trial. If found to be effective, it could be implemented in health, education, youth and social services, and charities, to not only help young people but also families, carers, friends, and professionals involved in their care. %M 29449202 %R 10.2196/mental.8894 %U http://mental.jmir.org/2018/1/e13/ %U https://doi.org/10.2196/mental.8894 %U http://www.ncbi.nlm.nih.gov/pubmed/29449202 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e3 %T A Computer-Assisted Personal Interview App in Research Electronic Data Capture for Administering Time Trade-off Surveys (REDCap): Development and Pretest %A Oremus,Mark %A Sharafoddini,Anis %A Morgano,Gian Paolo %A Jin,Xuejing %A Xie,Feng %+ School of Public Health and Health Systems, University of Waterloo, 200 University Ave W, Waterloo, ON,, Canada, 1 519 888 4567 ext 35129, moremus@uwaterloo.ca %K computer-assisted personal interview %K health-related quality-of-life %K REDCap %K time trade-off %D 2018 %7 23.01.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The time trade-off (TTO) task is a method of eliciting health utility scores, which range from 0 (equivalent to death) to 1 (equivalent to perfect health). These scores numerically represent a person’s health-related quality of life. Software apps exist to administer the TTO task; however, most of these apps are poorly documented and unavailable to researchers. Objective: To fill the void, we developed an online app to administer the TTO task for a research study that is examining general public proxy health-related quality of life estimates for persons with Alzheimer’s disease. This manuscript describes the development and pretest of the app. Methods: We used Research Electronic Data Capture (REDCap) to build the TTO app. The app’s modular structure and REDCap’s object-oriented environment facilitated development. After the TTO app was built, we recruited a purposive sample of 11 members of the general public to pretest its functionality and ease of use. Results: Feedback from the pretest group was positive. Minor modifications included clarity enhancements, such as rearranging some paragraph text into bullet points, labeling the app to delineate different question sections, and revising or deleting text. We also added a research question to enable the identification of respondents who know someone with Alzheimer’s disease. Conclusions: We developed an online app to administer the TTO task. Other researchers may access and customize the app for their own research purposes. %M 30684429 %R 10.2196/formative.8202 %U http://formative.jmir.org/2018/1/e3/ %U https://doi.org/10.2196/formative.8202 %U http://www.ncbi.nlm.nih.gov/pubmed/30684429 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e25 %T Young People’s, Parents’, and Professionals’ Views on Required Components of Mobile Apps to Support Self-Management of Juvenile Arthritis: Qualitative Study %A Waite-Jones,Jennifer M %A Majeed-Ariss,Rabiya %A Smith,Joanna %A Stones,Simon R %A Van Rooyen,Vanessa %A Swallow,Veronica %+ Faculty of Science, Charles Sturt University, Building 1293 Room 2, Bathurst,, Australia, 61 0419 490 431, v.m.swallow@leeds.ac.uk %K Adolescent %K young people %K juvenile arthritis %K mobile apps %K self-management %K qualitative research %D 2018 %7 19.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is growing evidence that supporting self-management of Juvenile Arthritis can benefit both patients and professionals. Young people with Juvenile Arthritis and their healthy peers increasingly use mobile technologies to access information and support in day-to-day life. Therefore, a user-led, rigorously developed and evaluated mobile app could be valuable for facilitating young people’s self-management of Juvenile Arthritis. Objective: The objective of this study was to seek the views of young people with Juvenile Arthritis, their parents or carers, and health care professionals (HCPs) as to what should be included in a mobile app to facilitate young people’s self-management of chronic Juvenile Arthritis. Methods: A qualitative approach was adopted with a purposeful sample of 9 young people aged 10-18 years with Juvenile Arthritis, 8 parents or carers, and 8 HCPs involved in their care. Data were gathered through semi-structured focus group and individual interviews with young people and their parents or carers and HCPs. Interview discussion was facilitated through demonstration of four existing health apps to explore participants’ views on strengths and limitations of these, barriers and facilitators to mobile app use, preferred designs, functionality, levels of interaction, and data sharing arrangements. Data were analyzed using the framework approach. Results: Analysis revealed three interlinked, overarching themes: (1) purpose, (2) components and content, and (3) social support. Despite some differences in emphasis on essential content, general agreement was found between young people with Juvenile Arthritis their parents or carers, and professionals that a mobile app to aid self-management would be useful. Underpinning the themes was a prerequisite that young people are enabled to feel a sense of ownership and control of the app, and that it be an interactive, engaging resource that offers developmentally appropriate information and reminders, as well as enabling them to monitor their symptoms and access social support. Conclusions: Findings justify and pave the way for a future feasibility study into the production and preliminary testing of such an app. This would consider issues such as compatibility with existing technologies, costs, age, and cross-gender appeal as well as resource implications. %M 29351898 %R 10.2196/mhealth.9179 %U http://mhealth.jmir.org/2018/1/e25/ %U https://doi.org/10.2196/mhealth.9179 %U http://www.ncbi.nlm.nih.gov/pubmed/29351898 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 1 %P e2 %T Digital Health Innovation: A Toolkit to Navigate From Concept to Clinical Testing %A Marvel,Francoise Adeline %A Wang,Jane %A Martin,Seth Shay %+ Ciccarone Center for the Prevention of Heart Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 7th Floor, Baltimore, MD, 21287, United States, 1 4105020469, fmarvel1@jhmi.edu %K digital health innovation models %K mHealth %K innovation framework %K development of smartphone applications %K wearable technology %K healthcare transformation %D 2018 %7 18.01.2018 %9 Viewpoint %J JMIR Cardio %G English %X Digital health technologies such as smartphone apps, Web-based platforms, and wearable devices are rapidly emerging as promising interventions for acute and chronic disease management, particularly in the field of cardiovascular medicine. However, there is limited guidance on how to effectively develop and rigorously test digital health interventions (DHIs). Through our experience with innovating Corrie, a smartphone-based app paired with a smartwatch and blood pressure monitor for myocardial infarction recovery in the acute setting, we aim to provide a toolkit for navigating the digital health technology development and clinical testing processes. The toolkit consists of 6 steps: step one emphasizes concept generation by defining a specific clinical problem and the existing solutions aimed to address it; step two aims to recruit a multidisciplinary team within an academic institution; step three leverages technology accelerators and industry partnerships; step four develops the digital health technology with continuous feedback from patient and family end-users; step five solicits feedback from a diverse array of stakeholders; and step six performs a clinical study at a single site that, if successful, rapidly scales to multiple sites. DHI development is often a complex and vastly uncharted territory. By exploring the steps we took from concept to clinical testing with the first cardiology CareKit app, we hope to provide useful insights to teams that are starting out on their path to digital health innovation. We emphasize the central importance of embracing transdisciplinary work to move from silos to synergy. %M 31758761 %R 10.2196/cardio.7586 %U http://cardio.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/cardio.7586 %U http://www.ncbi.nlm.nih.gov/pubmed/31758761 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 1 %P e6 %T Development of a Maternal, Newborn and Child mHealth Intervention in Thai Nguyen Province, Vietnam: Protocol for the mMom Project %A McBride,Bronwyn %A Nguyen,Liem Thanh %A Wiljer,David %A Vu,Nguyen C %A Nguyen,Cuong K %A O'Neil,John %+ Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A1S6, Canada, 1 778 782 5361, joneil@sfu.ca %K mobile health %K Vietnam %K maternal health %K reproductive health %K health equity %D 2018 %7 11.01.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Ethnic minority women (EMW) living in mountainous areas of northern Vietnam have disproportionately high infant and maternal mortality rates as a result of low maternal health knowledge, poverty, and remoteness from low-capacity health centers. Objective: The objective of this study was to describe the protocol for the development and evaluation of the mMom intervention, which is an integrated mobile health (mHealth) system designed to improve maternal and infant health knowledge, and behavior among women in remote areas of Thai Nguyen, Vietnam. Methods: This project featured the following four phases: (1) development of an mHealth platform integrated into the existing health management information system in partnership with the provincial health department; (2) ethnographic fieldwork and intervention content development; (3) intervention piloting and implementation; and (4) evaluation of the intervention’s impact on participants’ maternal health knowledge, behavior, and interactions with the health system. Results: The mMom project development process resulted in the following: (1) the successful development of the mMom system, including the mHealth platform hardware and integration, the intervention plan and content, and the monitoring and evaluation framework; (2) the piloting and implementation of the intervention as planned; and (3) the implementation of the monitoring and evaluation framework components. Conclusions: This protocol outlines the development of the mMom intervention and describes critical next steps in understanding the impact of the intervention on participants and the wider health system in Thai Nguyen province, Vietnam. %M 29326095 %R 10.2196/resprot.7912 %U http://www.researchprotocols.org/2018/1/e6/ %U https://doi.org/10.2196/resprot.7912 %U http://www.ncbi.nlm.nih.gov/pubmed/29326095 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 1 %P e11 %T Usage of an Exercise App in the Care for People With Osteoarthritis: User-Driven Exploratory Study %A Danbjørg,Dorthe Boe %A Villadsen,Allan %A Gill,Ester %A Rothmann,Mette Juel %A Clemensen,Jane %+ Centre for Innovative Medical Technology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Sdr Boulevard 29, Odense, 5000, Denmark, 45 26202186, dortheboe@gmail.com %K arthritis %K rehabilitation %K telemedicine %D 2018 %7 11.01.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Exercise has proven to reduce pain and increase quality of life among people living with osteoarthritis (OA). However, one major challenge is adherence to exercise once supervision ends. Objective: This study aimed to identify mental and physical barriers and motivational and social aspects of training at home, and to test or further develop an exercise app. Methods: The study was inspired from participatory design, engaging users in the research process. Data were collected through focus groups and workshops, and analyzed by systematic text condensation. Results: Three main themes were found: competition as motivation, training together, and barriers. The results revealed that the participants wanted to do their training and had knowledge on exercise and pain but found it hard to motivate themselves. They missed the observation, comments, and encouragement by the supervising physiotherapist as well as their peers. Ways to optimize the training app were identified during the workshops as participants shared their experience. Conclusions: This study concludes that the long-term continuation of exercising for patients with OA could be improved with the use of a technology tailored to users’ needs, including motivational and other behavioral factors. %M 29326092 %R 10.2196/mhealth.7734 %U https://mhealth.jmir.org/2018/1/e11/ %U https://doi.org/10.2196/mhealth.7734 %U http://www.ncbi.nlm.nih.gov/pubmed/29326092 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e1 %T Developing Digital Facilitation of Assessments in the Absence of an Interpreter: Participatory Design and Feasibility Evaluation With Allied Health Groups %A Freyne,Jill %A Bradford,Dana %A Pocock,Courtney %A Silvera-Tawil,David %A Harrap,Karen %A Brinkmann,Sally %+ Australian eHealth Research Centre, Commonwealth Scientific and Industrial Research Organisation, Queensland Centre for Advanced Technologies, 1 Technology Court, Pullenvale, 4069, Australia, 61 733274404, dana.bradford@csiro.au %K mobile apps %K cultural diversity %K culturally appropriate technology %K cross-cultural care %K language barriers %K health care delivery %K ehealth allied health %D 2018 %7 09.01.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: To ensure appropriate and timely care, interpreters are often required to aid communication between clinicians and patients from non-English speaking backgrounds. In a hospital environment, where care is delivered 24 hours a day, interpreters are not always available. Subsequently, culturally and linguistically diverse (CALD) patients are sometimes unable to access timely assessment because of clinicians’ inability to communicate directly with them. Objective: The aim of this study was to design and evaluate CALD Assist, a tablet app to assist communication between patients and allied health clinicians in the absence of an interpreter. CALD Assist uses key phrases translated into common languages and uses pictorial, written, and voice-over prompts to facilitate communication during basic patient assessment. Methods: CALD Assist’s design, functionality, and content were determined through focus groups with clinicians and informed by interpreting and cultural services. An evaluation was conducted in a live trial phase on eight wards across 2 campuses of a hospital in Victoria, Australia. Results: A commercial grade CALD Assist mobile app for five disciplines within allied health was developed and evaluated. The app includes a total of 95 phrases in ten different languages to assist clinicians during their initial assessment. Evaluation results show that clinicians’ confidence in their assessment increased with use of the CALD Assist app: clinicians’ reports of “complete confidence” increased from 10% (3/30) to 42% (5/12), and assessment reports of “no confidence” decreased from 57% (17/30) to 17% (2/12). Average time required to complete an assessment with patients from non-English speaking backgrounds reduced from 42.0 to 15.6 min. Conclusions: Through the use of CALD Assist, clinician confidence in communicating with patients from non-English speaking backgrounds in the absence of an interpreter increased, providing patients from non-English speaking backgrounds with timely initial assessments and subsequent care in line with their English speaking peers. Additionally, the inclusion of images and video demonstrations in CALD Assist increased the ability to communicate with patients and overcome literacy-related barriers. Although a number of hurdles were faced, user uptake and satisfaction were positive, and the app is now available in the Apple App Store. %M 30684405 %R 10.2196/formative.8032 %U http://formative.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/formative.8032 %U http://www.ncbi.nlm.nih.gov/pubmed/30684405 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 1 %P e1 %T Stage-Based Mobile Intervention for Substance Use Disorders in Primary Care: Development and Test of Acceptability %A Levesque,Deborah %A Umanzor,Cindy %A de Aguiar,Emma %+ Pro-Change Behavior Systems, Inc, 1174 Kingstown Road, Suite 101, South Kingstown, RI, 02879, United States, 1 401 360 2975, dlevesque@prochange.com %K pilot projects %K substance use disorders %K primary care %K behavioral medicine %K expert system %D 2018 %7 02.01.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: In 2016, 21 million Americans aged 12 years and older needed treatment for a substance use disorder (SUD). However, only 10% to 11% of individuals requiring SUD treatment received it. Given their access to patients, primary care providers are in a unique position to perform universal Screening, Brief Intervention, and Referral to Treatment (SBIRT) to identify individuals at risk, fill gaps in services, and make referrals to specialty treatment when indicated. Major barriers to SBIRT include limited time among providers and low motivation to change among many patients. Objective: The objective of this study was to develop and test the acceptability of a prototype of a mobile-delivered substance use risk intervention (SURI) for primary care patients and a clinical dashboard for providers that can address major barriers to SBIRT for risky drug use. The SURI delivers screening and feedback on SUD risk via mobile tools to patients at home or in the waiting room; for patients at risk, it also delivers a brief intervention based on the transtheoretical model of behavior change (TTM) to facilitate progress through the stages of change for quitting the most problematic drug and for seeking treatment if indicated. The prototype also delivers 30 days of stage-matched text messages and 4 Web-based activities addressing key topics. For providers, the clinical dashboard summarizes the patient’s SUD risk scores and stage of change data, and provides stage-matched scripts to guide in-person sessions. Methods: A total of 4 providers from 2 federally qualified health centers (FQHCs) were recruited for the pilot test, and they in turn recruited 5 patients with a known SUD. Furthermore, 3 providers delivered dashboard-guided SBIRT sessions and completed a brief acceptability survey. A total of 4 patients completed a Web-based SURI session and in-person SBIRT session, accessed other program components, and completed 3 acceptability surveys over 30 days. Questions in the surveys were adapted from the National Cancer Institute’s Education Materials Review Form. Response options ranged from 1=strongly disagree to 5=strongly agree. The criterion for establishing acceptability was an overall rating of 4.0 or higher across items. Results: For providers, the overall mean acceptability rating was 4.4 (standard deviation [SD] 0.4). Notably, all providers gave a rating of 5.0 for the item, “The program can give me helpful information about my patient.” For patients, the overall mean acceptability rating was 4.5 (SD 0.3) for the mobile- and provider-delivered SBIRT sessions and 4.0 (SD 0.4) for the text messages and Web-based activities. One highly rated item was “The program could help me make some positive changes” (4.5). Conclusions: The SURI program and clinical dashboard, developed to reduce barriers to SBIRT in primary care, were well received by providers and patients. %M 29295811 %R 10.2196/medinform.7355 %U http://medinform.jmir.org/2018/1/e1/ %U https://doi.org/10.2196/medinform.7355 %U http://www.ncbi.nlm.nih.gov/pubmed/29295811 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e7 %T Identifying Asbestos-Containing Materials in Homes: Design and Development of the ACM Check Mobile Phone App %A Govorko,Matthew Hayden %A Fritschi,Lin %A White,James %A Reid,Alison %+ School of Public Health, Curtin University, GPO Box U1987, Bentley, Perth, 6845, Australia, 61 8 9266 1361, alison.reid@curtin.edu.au %K application development %K asbestos %K asbestos-containing materials %K mobile phones %K smartphone %K residential environment %K mobile applications %K environment and public health %D 2017 %7 14.12.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Asbestos-containing materials (ACMs) can still be found in many homes in Australia and other countries. ACMs present a health risk when they are damaged or disturbed, such as during do-it-yourself home renovations. However, community members lack knowledge and awareness about asbestos identification and its safe management in residential settings. Objective: The objective of our study was to describe the process of developing a mobile phone app, ACM Check, that incorporates a questionnaire designed to identify and assess ACMs located in residential settings. Methods: A multidisciplinary team was involved in the formative development and creation of the mobile phone app. The formative development process comprised 6 steps: defining the scope of the app; conducting a comprehensive desktop review by searching online literature databases, as well as a wider online search for gray literature; drafting and revising the content, questionnaire, conditional branching rules, and scoring algorithms; obtaining expert input; manually pretesting the questionnaire; and formulating a final content document to be provided to the software development company. We then constructed ACM Check on the iOS platform for use in a validation study, and then updated the app, replicated it on Android, and released it to the public. Results: The ACM Check app identifies potential ACMs, prioritizes the materials based on their condition and likelihood of disturbance, and generates a summary report for each house assessed. Conclusions: ACM Check is an initiative to raise community members’ awareness of asbestos in the residential environment and also serves as a data collection tool for epidemiologic research. It can potentially be modified for implementation in other countries or used as the basis for the assessment of other occupational or environmental hazards. %M 30684427 %R 10.2196/formative.8370 %U http://formative.jmir.org/2017/1/e7/ %U https://doi.org/10.2196/formative.8370 %U http://www.ncbi.nlm.nih.gov/pubmed/30684427 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 4 %P e30 %T An eHealth Application of Self-Reported Sports-Related Injuries and Illnesses in Paralympic Sport: Pilot Feasibility and Usability Study %A Fagher,Kristina %A Jacobsson,Jenny %A Dahlström,Örjan %A Timpka,Toomas %A Lexell,Jan %+ Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, PO Box 157, Lund,, Sweden, 46 46 222 1991, kristina.fagher@med.lu.se %K epidemiology %K feasibility studies %K sports medicine %K sports for persons with disabilities %K telemedicine %D 2017 %7 29.11.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Sport participation is associated with a risk of sports-related injuries and illnesses, and Paralympic athletes’ additional medical issues can be a challenge to health care providers and medical staff. However, few prospective studies have assessed sports-related injuries and illnesses in Paralympic sport (SRIIPS) over time. Advances in mobile phone technology and networking systems offer novel opportunities to develop innovative eHealth applications for collection of athletes’ self-reports. Using eHealth applications for collection of self-reported SRIIPS is an unexplored area, and before initiation of full-scale research of SRIIPS, the feasibility and usability of such an approach needs to be ascertained. Objective: The aim of this study was to perform a 4-week pilot study and (1) evaluate the monitoring feasibility and system usability of a novel eHealth application for self-reported SRIIPS and (2) report preliminary data on SRIIPS. Methods: An eHealth application for routine collection of data from athletes was developed and adapted to Paralympic athletes. A 4-week pilot study was performed where Paralympic athletes (n=28) were asked to weekly self-report sport exposure, training load, general well-being, pain, sleep, anxiety, and possible SRIIPS. The data collection was followed by a poststudy use assessment survey. Quantitative data related to the system use (eg, completed self-reports, missing responses, and errors) were analyzed using descriptive statistics. The qualitative feasibility and usability data provided by the athletes were condensed and categorized using thematic analysis methods. Results: The weekly response rate was 95%. The athletes were of the opinion that the eHealth application was usable and feasible but stated that it was not fully adapted to Paralympic athletes and their impairments. For example, it was difficult to understand how a new injury or illness should be identified when the impairment was involved. More survey items related to the impairments were requested, as the athletes perceived that injuries and illnesses often occurred because of the impairment. Options for description of multifactorial incidents including an injury, an illness, and the impairment were also insufficient. Few technical issues were encountered, but athletes with visual impairment reported usability difficulties with the speech synthesizer. An incidence rate of 1.8 injuries and 1.7 illnesses per 100 hours of athlete exposure were recorded. The weekly pain prevalence was 56% and the impairment contributed to 20% of the reported incidents. Conclusions: The novel eHealth-based application for self-reported SRIIPS developed and tested in this pilot study was generally feasible and usable. With some adaptation to accommodate Paralympic athletes’ prerequisites and improved technical support for athletes with visual impairment, this application can be recommended for use in prospective studies of SRIIPS. Trial Registration: ClinicalTrials.gov NCT02788500; https://clinicaltrials.gov/ct2/show/NCT02788500 (Archived by WebCite at http://www.webcitation.org/6v56OqTeP) %M 29187343 %R 10.2196/humanfactors.8117 %U http://humanfactors.jmir.org/2017/4/e30/ %U https://doi.org/10.2196/humanfactors.8117 %U http://www.ncbi.nlm.nih.gov/pubmed/29187343 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 11 %P e230 %T An eHealth Intervention to Promote Physical Activity and Social Network of Single, Chronically Impaired Older Adults: Adaptation of an Existing Intervention Using Intervention Mapping %A Boekhout,Janet M %A Peels,Denise A %A Berendsen,Brenda AJ %A Bolman,Catherine AW %A Lechner,Lilian %+ Faculty of Psychology and Educational Science, Open University of the Netherlands, Postbus 2960, Valkenburgerweg 177, Heerlen, 6401 DL, Netherlands, 31 455762448, janet.boekhout@ou.nl %K exercise %K older adults %K single %K chronic disease %K eHealth %K social network %K Intervention Mapping %D 2017 %7 23.11.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Especially for single older adults with chronic diseases, physical inactivity and a poor social network are regarded as serious threats to their health and independence. The Active Plus intervention is an automated computer-tailored eHealth intervention that has been proven effective to promote physical activity (PA) in the general population of adults older than 50 years. Objective: The aim of this study was to report on the methods and results of the systematic adaptation of Active Plus to the wishes and needs of the subgroup of single people older than 65 years who have one or more chronic diseases, as this specific target population may encounter specific challenges regarding PA and social network. Methods: The Intervention Mapping (IM) protocol was used to systematically adapt the existing intervention to optimally suit this specific target population. A literature study was performed, and quantitative as well as qualitative data were derived from health care professionals (by questionnaires, n=10) and the target population (by focus group interviews, n=14), which were then systematically integrated into the adapted intervention. Results: As the health problems and the targeted behavior are largely the same in the original and adapted intervention, the outcome of the needs assessment was that the performance objectives remained the same. As found in the literature study and in data derived from health professionals and focus groups, the relative importance and operationalization of the relevant psychosocial determinants related to these objectives are different from the original intervention, resulting in a refinement of the change objectives to optimally fit the specific target population. This refinement also resulted in changes in the practical applications, program components, intervention materials, and the evaluation and implementation strategy for the subgroup of single, chronically impaired older adults. Conclusions: This study demonstrates that the adaptation of an existing intervention is an intensive process in which adopting the IM protocol is an invaluable tool. The study provides a broad insight in adapting interventions aimed at single older adults with a chronic disease. It is concluded that even when the new target population is a sizable segment of the original target population, the adapted intervention still needs considerable changes to optimally fit the needs and situational differences of the narrower target population. %M 29170146 %R 10.2196/resprot.8093 %U http://www.researchprotocols.org/2017/11/e230/ %U https://doi.org/10.2196/resprot.8093 %U http://www.ncbi.nlm.nih.gov/pubmed/29170146 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e6 %T A Health Professional–Led Synchronous Discussion on Facebook: Descriptive Analysis of Users and Activities %A Grainger,Rebecca %A White,Bonnie %A Morton,Catherine %A Day,Karen %+ Rehabilitation Research and Teaching Unit, Department of Medicine, University of Otago Wellington, 23a Mein St, PO Box 7343, Wellington South, 6242, New Zealand, 64 43855541 ext 4031, rebecca.grainger@otago.ac.nz %K social media %K arthritis %K patient education %K patient engagement %D 2017 %7 22.11.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Arthritis is a major cause of pain and disability. Arthritis New Zealand (Arthritis NZ) is a nongovernmental organization that provides advocacy, information, and advice and support services for people with arthritis in New Zealand. Since many people seek health information on the Web, Arthritis NZ has a webpage and a Facebook page. In addition to static content, Arthritis NZ provides synchronous discussions with an arthritis educator each week via Facebook. Objective: The aim of this study was to describe participation and structure of synchronous discussion with a health educator on a social media platform and the type of information and support provided to people with arthritis during discussions on this social media platform. Methods: Interpretive multimethods were used. Facebook Analytics were used to describe the users of the Arthritis NZ Facebook page and to provide descriptive summary statistics. Graphic analysis was used to summarize activity during a convenience sample of 10 arthritis educator–led synchronous discussions. Principles of thematic analysis were used to interpret transcripts of all comments from these 10 weekly arthritis educator–led discussions. Results: Users of the Arthritis NZ Facebook page were predominantly female (1437/1778, 80.82%), aged 18 to 54 years. Three major activities occurred during arthritis educator–led synchronous discussions: (1) seeking or giving support; (2) information enquiry; and (3) information sharing across a broad range of topic areas, largely related to symptoms and maintaining physical functioning. There was limited peer-to-peer interaction, with most threads consisting of two-comment exchanges between the users and arthritis educators. Conclusions: Arthritis educator–led discussions provided a forum for informational and emotional support for users. The facilitated discussion forum for people with arthritis on Facebook could be enhanced by encouraging increased user participation and increasing peer-to-peer interactions and further training of arthritis educators in facilitation of Web-based discussion. Future research should focus on addressing barriers to user participation and assessing the impact of arthritis educator facilitation training, with the latter leveraging the Action Research paradigm. %M 30684425 %R 10.2196/formative.7257 %U http://formative.jmir.org/2017/1/e6/ %U https://doi.org/10.2196/formative.7257 %U http://www.ncbi.nlm.nih.gov/pubmed/30684425 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e5 %T Implications for Training on Smartphone Medication Reminder App Use by Adults With Chronic Conditions: Pilot Study Applying the Technology Acceptance Model %A Park,Daniel Y %A Goering,Elizabeth M %A Head,Katharine J %A Bartlett Ellis,Rebecca J %+ Department of Communication Studies, Indiana University-Purdue University Indianapolis, 425 University Boulevard, Indianapolis, IN, 46202, United States, 1 317 278 3136, bgoering@iupui.edu %K chronic disease %K education of patients %K medication adherence %K mHealth %K mobile apps %K smartphone %D 2017 %7 10.11.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The majority of middle-aged to older patients with chronic conditions report forgetting to take medications as prescribed. The promotion of patients’ smartphone medication reminder app (SMRA) use shows promise as a feasible and cost-effective way to support their medication adherence. Providing training on SMRA use, guided by the technology acceptance model (TAM), could be a promising intervention to promote patients’ app use. Objective: The aim of this pilot study was to (1) assess the feasibility of an SMRA training session designed to increase patients’ intention to use the app through targeting perceived usefulness of app, perceived ease of app use, and positive subjective norm regarding app use and (2) understand the ways to improve the design and implementation of the training session in a hospital setting. Methods: A two-group design was employed. A total of 11 patients older than 40 years (median=58, SD=9.55) and taking 3 or more prescribed medications took part in the study on one of two different dates as participants in either the training group (n=5) or nontraining group (n=6). The training group received an approximately 2-hour intervention training session designed to target TAM variables regarding one popular SMRA, the Medisafe app. The nontraining group received an approximately 2-hour control training session where the participants individually explored Medisafe app features. Each training session was concluded with a one-time survey and a one-time focus group. Results: Mann-Whitney U tests revealed that the level of perceived ease of use (P=.13) and the level of intention to use an SMRA (P=.33) were higher in the training group (median=7.00, median=6.67, respectively) than in the nontraining group (median=6.25, median=5.83). However, the level of perceived usefulness (U=4.50, Z=−1.99, P=.05) and the level of positive subjective norm (P=.25) were lower in the training group (median=6.50, median=4.29) than in the nontraining group (median=6.92, median=4.50). Focus groups revealed the following participants’ perceptions of SMRA use in the real-world setting that the intervention training session would need to emphasize in targeting perceived usefulness and positive subjective norm: (1) the participants would find an SMRA to be useful if they thought the app could help address specific struggles in medication adherence in their lives and (2) the participants think that their family members (or health care providers) might view positively the participants’ SMRA use in primary care settings (or during routine medical checkups). Conclusions: Intervention training session, guided by TAM, appeared feasible in targeting patients’ perceived ease of use and, thereby, increasing intention to use an SMRA. Emphasizing the real-world utility of SMRA, the training session could better target patients’ perceived usefulness and positive subjective norm that are also important in increasing their intention to use the app. %M 30684397 %R 10.2196/formative.8027 %U http://formative.jmir.org/2017/1/e5/ %U https://doi.org/10.2196/formative.8027 %U http://www.ncbi.nlm.nih.gov/pubmed/30684397 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e4 %T Using mHealth to Support Postabortion Contraceptive Use: Results From a Feasibility Study in Urban Bangladesh %A Biswas,Kamal Kanti %A Hossain,Altaf %A Chowdhury,Rezwana %A Andersen,Kathryn %A Sultana,Sharmin %A Shahidullah,S M %A Pearson,Erin %+ Ipas, P.O. Box 9990, Chapel Hill, NC, 27515, United States, 919 967 7052, andersenk@Ipas.org %K mHealth %K Bangladesh %K contraceptive usage %K postabortion contraception %D 2017 %7 27.10.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: As access to mobile technology improves in low- and middle-income countries, it becomes easier to provide information about sensitive issues, such as contraception and abortion. In Bangladesh, 97% of the population has access to a mobile signal, and the equity gap is closing in mobile phone ownership. Bangladesh has a high pregnancy termination rate and improving effective use of contraception after abortion is essential to reducing subsequent unwanted pregnancies. Objective: This study examines the feasibility and acceptability of implementing a short message service (SMS) text message-based mHealth intervention to support postabortion contraceptive use among abortion clients in Bangladesh, including women’s interest in the intervention, intervention preferences, and privacy concerns. Methods: This feasibility study was conducted in four urban, high abortion caseload facilities. Women enrolled in the study were randomized into an intervention (n=60) or control group (n=60) using block randomization. Women completed a baseline interview on the day of their abortion procedure and a follow-up interview 4 months later (retention rate: 89.1%, 107/120). Women in the intervention group received text message reminders to use their selected postabortion contraceptive methods and reminders to contact the facility if they had problems or concerns with their method. Women who did not select a method received weekly messages that they could visit the clinic if they would like to start a method. Women in the control group did not receive any messages. Results: Almost all women in the feasibility study reported using their mobile phones at least once per day (98.3%, 118/120) and 77.5% (93/120) used their phones for text messaging. In the intervention group, 87% (48/55) of women were using modern contraception at the 4-month follow-up, whereas 90% (47/52) were using contraception in the control group (P=.61). The intervention was not effective in increasing modern contraceptive use at follow-up, but 93% (51/55) of women reported at follow-up that the text reminders helped them use their method correctly and 76% (42/55) said they would sign up for this service again. Approximately half of the participants (53%, 29/55) said that someone they did not want to know about the text message reminders found out, mostly their husbands or children. Conclusions: In this small-scale feasibility study, text reminders did not increase postabortion contraceptive use. Despite the ineffectiveness of the text reminder intervention, implementation of a mHealth intervention among abortion clients in urban Bangladesh was feasible in that women were interested in receiving follow-up messages after their abortion and mobile phone use was common. Text messages may not be the best modality for a mHealth intervention due to relatively low baseline SMS text message use and privacy concerns. %M 30684398 %R 10.2196/formative.5151 %U http://formative.jmir.org/2017/1/e4/ %U https://doi.org/10.2196/formative.5151 %U http://www.ncbi.nlm.nih.gov/pubmed/30684398 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e3 %T Videoconferencing-Based Treatment of Alcohol Use Disorders: Analyses of Nonparticipation %A Tarp,Kristine %A Mejldal,Anna %A Nielsen,Anette Søgaard %+ Unit of Clinical Alcohol Research, Department of Clinical Research, University of Southern Denmark, J.B. Winsløws Vej 18, Indgang 220B, Odense C, 5000, Denmark, 45 6550 9359, ktarp@health.sdu.dk %K nonparticipation %K refusal to participate %K barriers %K treatment of alcohol use disorders %K alcoholism %K treatment refusal %K videoconferencing %K effectiveness %K treatment outcome %D 2017 %7 28.09.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: We recently conducted a small randomized controlled trial (RCT) aiming to examine the effectiveness of videoconferencing-based treatment of alcohol use disorders in a real-life setting. The patient and participation rates were lower than anticipated. Objective: The objectives of our study were (1) to examine differences between participants and nonparticipants, and (2) to examine the characteristics of nonparticipants and their reported reasons for not participating. Methods: First, we analyzed nonparticipation through a comparative analysis of participants and nonparticipants using data from a clinical database, covering all patients starting treatment at the clinic. Second, on the basis of data from an anonymous questionnaire filled out by nonparticipants, we analyzed barriers to participating and the descriptive sociodemographics of nonparticipants who reported technical barriers versus those who did not. Results: Of 128 consecutive patients starting treatment during the study period, we found no significant differences between participants (n=71) and nonparticipants (n=51) according to sociodemographics, alcohol measures, and composite scores. Of 51 nonparticipants, 43 filled out the questionnaire with reasons for not participating. We derived 2 categories of barriers from the questionnaire: scientific barriers, which were barriers to the scientific study in general (n=6), and technical barriers, which were barriers to using a laptop or videoconferencing specifically (n=27). We found no significant differences in sociodemographics between nonparticipants who reported technical barriers to participating in the study and those who did not note technical barriers. A total of 13 patients elaborated on technical barriers, and 9 patients found videoconferencing impersonal, preferred personal contact, and would rather attend face-to-face treatment at the clinic. Conclusions: Patient barriers to participating in the RCT were mainly concerned with the technology. There were no significant differences between participants and nonparticipants, nor between nonparticipants who noted technical barriers to participating and those who did not. If a similar study is to be conducted or the solution is to be upscaled and implemented, attention should be given to the user friendliness of the technical equipment and the recruitment process, preparing the patients by emphasizing the information given to them about the technical equipment and its advantages. %M 30684431 %R 10.2196/formative.6715 %U http://formative.jmir.org/2017/1/e3/ %U https://doi.org/10.2196/formative.6715 %U http://www.ncbi.nlm.nih.gov/pubmed/30684431 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e2 %T A Novel Patient Engagement Platform Using Accessible Text Messages and Calls (Epharmix): Feasibility Study %A Som,Avik %A Patel,Kunjan %A Sink,Eric %A Peters,Robert Mattson %A Javaherian,Kavon %A Groenendyk,Jacob %A An,Tonya %A Xu,Zhuchen %A Polites,Gregory M %A Blanchard,Melvin %A Ross,Will %+ Department of Internal Medicine, Renal Division, Washington University School of Medicine, Box 8023, 660 South Euclid Avenue, St. Louis, MO,, United States, 1 314 362 6861, rossw@wustl.edu %K telemedicine %K mobile health %K eHealth %K telehealth %K mHealth innovations %K bioinformatics %K multiple chronic conditions %D 2017 %7 18.09.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Patient noncompliance with therapy, treatments, and appointments represents a significant barrier to improving health care delivery and reducing the cost of care. One method to improve therapeutic adherence is to improve feedback loops in getting clinically acute events and issues to the relevant clinical providers as necessary (ranging from detecting hypoglycemic events for patients with diabetes to notifying the provider when patients are out of medications). Patients often don’t know which information should prompt a call to their physician and proactive checks by the clinics themselves can be very resource intensive. We hypothesized that a two-way SMS system combined with a platform web service for providers would enable both high patient engagement but also the ability to detect relevant clinical alerts. Objective: The objectives of this study are to develop a feasible two-way automated SMS/phone call + web service platform for patient-provider communication, and then study the feasibility and acceptability of the Epharmix platform. First, we report utilization rates over the course of the first 18 months of operation including total identified clinically significant events, and second, review results of patient user-satisfaction surveys for interventions for patients with diabetes, COPD, congestive heart failure, hypertension, surgical site infections, and breastfeeding difficulties. Methods: To test this question, we developed a web service + SMS/phone infrastructure (“Epharmix”). Utilization results were measured based on the total number of text messages or calls sent and received, with percentage engagement defined as a patient responding to a text message at least once in a given week, including the number of clinically significant alerts generated. User satisfaction surveys were sent once per month over the 18 months to measure satisfaction with the system, frequency and degree of communication. Descriptive statistics were used to describe the above information. Results: In total, 28,386 text messages and 24,017 calls were sent to 929 patients over 9 months. Patients responded to 80% to 90% of messages allowing the system to detect 1164 clinically significant events. Patients reported increased satisfaction and communication with their provider. Epharmix increased the number of patient-provider interactions to over 10 on average in any given month for patients with diabetes, COPD, congestive heart failure, hypertension, surgical site infections, and breastfeeding difficulties. Conclusions: Engaging high-risk patients remains a difficult process that may be improved through novel, digital health interventions. The Epharmix platform enables increased patient engagement with very low risk to improve clinical outcomes. We demonstrated that engagement among high-risk populations is possible when health care comes conveniently to where they are. %M 30684401 %R 10.2196/formative.7211 %U http://formative.jmir.org/2017/1/e2/ %U https://doi.org/10.2196/formative.7211 %U http://www.ncbi.nlm.nih.gov/pubmed/30684401 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 8 %P e161 %T Engaging Adolescents to Inform the Development of a Mobile Gaming App to Incentivize Physical Activity %A Pope,Lizzy %A Garnett,Bernice %A Dibble,Marguerite %+ University of Vermont, 533 Waterman Building, 85 South Prospect St, Burlington, VT, 05405, United States, 1 802 656 2187, bgarnett@uvm.edu %K adolescents %K qualitative research %K mHealth %K physical activity %D 2017 %7 29.08.2017 %9 Short Paper %J JMIR Res Protoc %G English %X Background: Involving youth in the development of a mobile game designed to increase physical activity may increase relevancy and adoption. Objective: To share the development process used to create a gaming app aimed at incentivizing physical activity in high school students. Methods: Five focus groups were conducted with high school students (N=50) to understand gaming behaviors. A subset of students from the focus groups chose to complete a Web-based survey (N=10). Four different versions of gaming artwork and concept design based on student input were pilot tested (N=35), and group consensus building determined the direction of the game. The 4 game versions differed in their artwork style and gaming concept with some requiring competition versus cooperation, or being more individual versus team based. Group consensus building meant that all artwork and game concept options were displayed at the front of a classroom. Students could then vote for their top artwork and concept choices by putting stickers on the top 1 or 2 artwork and concept options that they liked best. Once all votes were cast, investigators discussed the voting results with students, and brainstormed ways to incorporate popular aspects of the 3 “losing” artwork and game concepts into the winning ideas. Results: Focus group transcripts were analyzed for common themes. Artwork and gaming concept-voting data was tallied at the time of voting to share with students in real time. Focus groups and survey results revealed important themes for a successful gaming app: (1) competition, (2) balanced in-game rewards, (3) accessibility, and (4) aesthetic features. Consensus voting indicated the popularity of a collaborative competitive content design (35/66, 53%) and playful art (27/71, 38%). Conclusions: To ensure saliency and effectiveness of game-based physical activity interventions, youth need to be included in design and implementation. Furthermore, the unique preferences and social constructs of high school students need to be considered during intervention development. %M 28851676 %R 10.2196/resprot.8113 %U http://www.researchprotocols.org/2017/8/e161/ %U https://doi.org/10.2196/resprot.8113 %U http://www.ncbi.nlm.nih.gov/pubmed/28851676 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 1 %N 1 %P e1 %T The Impact of Participant Characteristics on Use and Satisfaction of a Web-Based Computer-Tailored Chronic Obstructive Pulmonary Disease Self-Management Intervention: A Process Evaluation %A Voncken-Brewster,Viola %A Amoureus,Mylène %A de Vries,Hein %A Nagykaldi,Zsolt %A Winkens,Bjorn %A van der Weijden,Trudy %A Tange,Huibert %+ Department of Family Medicine, Care and Public Health Research Institute, Maastricht University Medical Center, Maastricht University, PO Box 616, Maastricht,, Netherlands, 31 43 388 2230, viola.voncken@maastrichtuniversity.nl %K Internet intervention %K computer tailoring %K application use %K participant characteristics %K COPD %K self-management %K behavior change %K process evaluation %D 2017 %7 21.08.2017 %9 Original Paper %J JMIR Formativ Res %G English %X Background: A randomized controlled trial (RCT) showed that a Web-based computer-tailored self-management intervention for people with or at risk for chronic obstructive pulmonary disease (COPD) did not have a significant treatment effect. Process evaluation measures such as application use and satisfaction with the intervention can help understand these results. Objectives: The aim of this paper is to uncover reasons for suboptimal application use, evaluate satisfaction with the intervention, and investigate which participant characteristics predict application use and user satisfaction. Methods: Participants were recruited through 2 different channels: an online panel and general practice. The intervention group received the intervention, which consisted of 2 modules (smoking cessation and physical activity). The control group received no intervention. The study employed a mixed methods design. Quantitative and qualitative data were gathered assessing participant characteristics, application use, reasons for not using the application, and satisfaction with the intervention. Results: The RCT included 1325 participants. The proportion of individuals who participated was significantly higher in the online group (4072/6844, 59.5%) compared to the general practice group (43/335, 12.8%) (P<.001). Application use was low. Of all participants in the intervention group, 52.9% (348/658) initiated use of one or both modules, 36.0% (237/658) completed an intervention component (prolonged use), and 16.6% (109/658) revisited one of the modules after completing an intervention component (sustained use). Older age, established diagnosis of COPD, or experiencing breathlessness predicted sustained use. Participant satisfaction with the 2 modules was 6.7 (SD 1.6) on a scale from 0 to 10. The interviews revealed that a computer application was believed not to be sufficient and the help of a health care professional was necessary. Participants with a greater intention to change were more satisfied with the application. Conclusions: The application was not used sufficiently. Study materials should be further tailored to younger individuals, those at risk for COPD, and those who do not experience breathlessness in order to increase sustained use among them. Involvement of a health care professional could improve satisfaction with the intervention and potentially increase engagement with the intervention materials. However, to make this possible, recruitment in general practice needs to be improved. Recommendations are made for improving the study design, strengthening the intervention (eg, practice facilitation), and linking the computer application to interaction with a health care provider. %M 30684399 %R 10.2196//formative.6585 %U https://formative.jmir.org/2017/1/e1/ %U https://doi.org/10.2196//formative.6585 %U http://www.ncbi.nlm.nih.gov/pubmed/30684399